In addition to the traditional third party collection services, LDB & Associates has developed an array of collection solutions that can be used to maintain an accounts receivable system, whether commercial or consumer.

 

Domestic or Foreign Debtor Claim Form
(* indicates required fields)

To place an account for collection, please complete the form below.

Please click here when submitting this form for a debtor for collection that is located in one of the 50 United States or their territories, Canada or Puerto Rico.

Please click here when submitting this form for a debtor for collection that is NOT located in one of the 50 United States or their territories, Canada or Puerto Rico.
New Client Existing Client
LDB Client No. (existing client)
Company Name:
 *
Contact Name:
*
Address:
 *
City:
 *
State:
 * Zip: *
Country:
Telephone:
 *
Fax:
E-Mail:
 *
Debtor Information
Company Name:
 *
Contact Name:
*
Address:
 *
City:
 *
State:
 *Zip: *
Country:
Telephone:
 *
Account Number:
 *
Debtor is a:
 Sole Proprietorship
Partnership
Corporation
Debtor Financial Information
Outstanding Balance:
 *
Last Charge Date:
Date of Last Payment:
I will be submitting the following documentation:
Statement of Account
 Credit Application
Invoice Copies
 Personal/Corporate Guaranty
Correspondence
Bad Check Copies
Other
Comments and/or Special Instructions
Please send a Ten (10) day Final Notice to the above debtor.

Please read the following carefully

I am authorizing LDB Associates, LLC (LDB) to commence collection action against the above debtor. LDB is also authorized to accept the debtor's payment (s) and deposit the payment (s) into their trust account on my company's behalf. I have read and accept LDB's fee schedule for this debtor.
Your Name: *


 

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