Debt Recovery Form

Creditor

Contact name:

Email:

Telephone number:

You can find my company name and address in the attachment(s)

Company

Building

Sublocation

Floor

Address

City

State

ZIP code

Country

Debtor

Please add a summary of the outstanding amounts, including invoice number and the terms of payment. If possible please add any other relevant correspondence. (copy of the invoice(s), reminders etc.)

You can find the Debtor information in the attachment(s)

Telephone number

Fax number

Email

Forwarding

Company

Contact name

Address

City

State

ZIP code

Country

Email

Telephone number

Remarks

I agree with the price matrix

I agree with the Bierens debt collection policy

We love to discuss your ideas further. Contact us.