Collector's Name 

Your Company 

Your Email address 

Your Toll Free Phone Number 

Your Phone Extension 

Your Fax Number 

File Number 

How Many Days  HowManyDays 5 3 7

Manager's OK 

Debtor Company 

Street Address 

City       State        Zip 

Phone 

Attention: to whom 

Amount Due 

Creditor 

How would you like it transmitted?  U.S. Mail (standard service) Fax + U.S. Mail (standard service) Certified U.S. Mail  (add $5.59 + $5.00 Handling) Fax + Certified U.S. Mail  (add $5.59 + $5.00 Handling) Hand Delivered By Rock Your Shipping Company (account number required) Fax only (must indicate fax number on next line)

Debtor's fax number or your shipping account number (if applicable)

I am aware that this is a commercial debt, and the Miranda and Validation warnings are NOT required.  Therefore, please indicate if you would like any of the following included in the letter:

Miranda  Yes No  

Validation  No Yes

N/G or NSF check  No Yes

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.