Creditor/Client Information

Email Address  
Client Name   
Contact Name  
Address 1     
Address 2     
City       State  Zip Code
Phone Number      Fax Number

Debtor Information

Company Name
Owner/Principal
Contact Name
Address 1
Address 2   
City   State  
 Zip Code
Phone Number   Fax Number
Customer #   Email
Debtor's Bank Bank Phone
Debtor is a Corporation Partnership Sole Proprietorship


Claim Information

Amount of Debt        
Date of Oldest Invoice  
Date of Last Payment   
Terms of Sale   Open Account Letter of Credit
Did buyer receive goods?   Yes No
Did buyer receive Bill of Lading (title documents)?   Yes No
Please Mark All That Apply  
(To select more than one: hold down CONTROL and click with mouse)
Other (please specify)  
I will be forwarding the following documents  
(To select more than one: hold down CONTROL and click with mouse) 		by Mail
by Fax
by Email Attachment
Comments or Special Instructions  

      

Latest News:

Marcus L. Arky was featured in EXPO Magazine's April 2006 publication in which he discusses exhibitor contracts. MORE>>

On November 29, 2006, MetroGroup exhibited at IAEE's (f/k/a IAEM's) Expo! Expo!. MORE>>

 
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