Non-Landlord & Tenant Collections
General Information
Total debt amount:
$
Case Type
Small claims
Civil action
Creditor Information
Name:
Middle Name:
Last Name:
Creditor/Corporation:
Building #:
Street Address:
Street Address 2:
City:
State:
ZIP Code:
Telephone:
E-mail:
Debtor Information
Name:
Middle Name:
Last Name:
Building #:
Street Address:
Street Address 2:
City:
State:
ZIP Code:
Telephone:
Social Security:
Name of Bank:
Account Number:
Employment/Corporation Information
Corporation:
Building #:
Street Address:
Street Address 2:
City:
State:
ZIP Code:
Telephone:
Position:
Supervisor:
Court Proceedings
Was There a Case In Court Regarding This Debt?
No
Yes
Court Name:
Building #:
Street Address:
Street Address 2:
City:
State:
ZIP Code:
What Is The Index Number?
What Attorney Handled The Process?
Is There/Was There a Judgement?
No
Yes
Amount:
$
Date:
Copy of the Judgement:
Comments
Submit Case