Collection Referral Form
Fax a copy of your ledger showing:
Balance Due
Copy of Credit Application
Copy of all outstanding invoices & payments made
To: (480) 452-0351
Attn:
Collections Department
Complete as much information as you have.
Your Information
Today's Date
Your Company's Name
(Required)
Company Phone & Fax
,
(Required)
Your Name
(Required)
Your Title
(Required)
Your Email Address
(Required)
Mechanic Lien done on this Job
Yes /
No
Customer Information
Customer`s Name
(Required)
Customer`s Contact Person
Customer`s Address
(Required)
Customer City, State, Zip
,
,
(Required)
Phone & Fax
,
Customer`s Account Number
Additional Information
Debt Amount Due
Date Last Paid
Comments
Contact
/
Company
/
Services
/
F.A.Q.
/
Forms
/
Timetable
/
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