Name: Collect My Debt Ltd
Address: 85 Great Portland Street, First Floor, London, W1W 7LT
Telephone: 0800-612-5161

Debt Recovery Instruction Form

If you cannot confirm the current details for the person in question, the likelihood of success is significantly reduced Please also complete a Trace Investigation Instruction form
Defaulter Details*
Forename Surname D.O.B. Email: Tel No:
Address:*
Street Address Address Line 2 City County Postal Code Country
Amount Overdue:*
Please attach supportive information such as Invoice, Statement of Arrears, Agreements etc.
Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 16 MB.
Type of Business*
- Limited Company
- Sole Trader
- Partnership
- Individual
Trading As:
Additional Defaulter Information
Instructing Client Details
Company name:
Your Name:*
First Last
Your contact details:
Tel No: Mobile No: Email Address:
Invoice Address:*
Street Address Address Line 2 City County Postal Code Country
Remittance Details:*
Bank Name: Bank Address: Account No: Sort Code Reference:
Notes: Payments remitted to you during the first week of each calendar month. Percentage commission of debt monies recovered (15% plus VAT - Under 5K) (8% plus VAT - 5K to 10K) ( 5% plus VAT - Over 10K)
CAPTCHA
It is a condition of this instruction that all directors, shareholders and members of the Claimant Company (where applicable) personally guarantee Collect My Debt Limited's fees, costs and charges. Review our Terms & Conditions*
- I agree to the Terms and Conditions
It is a condition of this instruction that all directors, shareholders and members of the Claimant Company (where applicable) personally guarantee Collect My Debt Limited's fees, costs and charges.

Review our Terms & Conditions
Signature:*
Please sign below to Instruct us and accept our Terms & Conditions - you can sign this using either a mobile / tablet touch screen or PC Mouse / laptop mouse pad
Date of Instruction
DD slash MM slash YYYY

Debt Recovery Instruction Form

If you cannot confirm the current details for the person in question, the likelihood of success is significantly reduced Please also complete a Trace Investigation Instruction form

Instructing Client Details

Notes: Payments remitted to you during the first week of each calendar month. Percentage commission of debt monies recovered (15% plus VAT - Under 5K) (8% plus VAT - 5K to 10K) ( 5% plus VAT - Over 10K)

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