Commercial & Debt Collection Agency - Account Adjustment Bureau

Online Collection Agency

Please complete the following form and tell us more about your debt collection needs. All information sent through the internet from this form is secure and will be received and responded to during our office hours, or the next working day. Please read our agreement first.

Client Information

Company Name:
Contact Name:
Address:
City:
State/Prov:
Zip/Postal Code:
Country:
Phone 1:	Area Code -
Phone 2:	Area Code -
Email:
Fax:	Area Code -

Debtor Information

Name of Account:
Responsible/Owner/ Officer/Party :
Address:
City:
Prov/State:
Postal Code/Zip:
Country:
Phone 1:	Area Code -
Phone 2:	Area Code -
Balance Due:	$
Last Date of Transaction:
Type of Service:	Regular 10 Day Demand