R & I :: Assignment for Field Visit (A&L)

ASSIGNMENT FOR FIELD VISIT (A&L) Pricing - based on city Please fill out this form so we can start your file. If you have any questions, call us at (818) 997-3868.
	ASSIGNMENT FOR FIELD VISIT (A&L)
	Name of Agency Collector Collector's Toll Free Phone Extension Email address: File Number Client City and State of your client Debtor Street Address City State Zip Phone Number Contact Person #1 Contact Person #2 (if applicable) Contact Person #3 (if applicable) How much is owed From what date What has transpired: By clicking SUBMIT your information will be delivered to us electronically and you will be taken to a confirmation page so you can print out what you sent us.