Your/Company Name (Creditor)
Your Address
Street
City
Zip
State
Your Telephone Number
Contact Person
File Number
State/Country Where Debt Was Incurred
Your Email Address
................................
Debtor's Name
Address #
Street
City
State
Zip
Debtor's Telephone Number
Debtor's Contact Person
Amount Owed
Origin of Debt
Date of Last Charge
Status/Collection Effort To Date
*Please attach any and all documentation relating to this claim (eg. Statement of Account, Invoices, Contract, etc.).
**Entry of a Sister State judgment may require a Substitution of Attorney form (which we will submit to you) and a notarized/exemplified copy of the original judgment (which you will submit to us).
Attachment
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