FILL IN THE FORM TO SUBMIT A COLLECTION ORDER

Applicant Information

Principal*

CompanyPrivate person

Name of the company*

Business-ID*

Contact Person*

Your bank account number for billing in IBAN*

Choose bank*

Address*

Postcode*

City*

Phone*

Email*

Debtor Information

Debtor*

CompanyPrivate person

Name of the company*

Business-ID*

Name of debtor*

Address*

Postcode*

City*

Email*

Delivery method of the invoice*

Invoice Details

Invoice number/Reference number*

Open capital including VAT*

Date of the invoice*

The due date of the invoice*

Late payment interest (%)*

Attach your original invoice*

No file Selected

Attach original invoice

Receiving grounds

The Debt is based on a contract

At least one payment reminder has been sent for a claim*

I declare that the claim is uncontested and that the debtor has not made any complaint about the claim

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I have read General terms and conditions for fast debt collection services, Service description and pricing and I accept them*

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