Capitol Commercial Collections: Collecting Debts around the world

CAPITOL COMMERCIAL COLLECTIONS

Tel: 020 8343 8373 Fax: 020 8343 7883

NO RESULT - NO FEE DEBT COLLECTION SERVICE

ADVICE OF OUTSTANDING DEBTS

Please complete the form if you wish to instruct us or discuss a single debt.

If you wish to discuss your debts and commission rates, please go to "contact us" for telephone, fax and e.mail details.

Click here to "print" this form

TRADING NAME:....................................................................

CONTACT NAME:...................................................................

DATE: ...................................................................................

TEL NO: ................................................................................

FAX NO: ................................................................................

JOB TITLE: ............................................................................

E.MAIL: .................................................................................

NO SUCCESS - NO FEE COLLECTION SERVICES

10% commission on debts up to 6 months old - 20% Commission on all older items

These rates apply for debt values from £500 to £10,000 for UK debt collection (inc. N. Ireland). For debts outside the UK or under £500 in UK, an additional 5% commission will be charged. Rates are negotiable for debts over £10,000.

Details of the debt you want collected:-

Debtors Trading Name:

_____________________________________________

Contact Name (Mr/Mrs/Miss/Ms)

_____________________________________________

Number of invoices:

_____________________________________________

Total Debt value:

_____________________________________________

Please confirm the currency if it is not Sterling:

_____________________________________________

Debt disputed?

_____________________________________________

Debtors Address:

_____________________________________________

Post/Zip Code:

_____________________________________________

Tel No:

_____________________________________________

Fax No:

_____________________________________________

e.mail address (if known):

_____________________________________________

Details of recovery actions carried out to date:-

_____________________________________________

Any additional information that may help Capitol in their collection procedures:

_____________________________________________

By submitting this completed form you are agreeing to pay commission at our stated rates for successful recovery, as set out on the page "commission rates" and that you have had the opportunity to read our Terms & Conditions.

In addition, you are agreeing that the debt submitted is a valid, legally incurred debt and that you are the correct beneficiary of any money we recover.

You are hereby giving us permission to receive money on your behalf should the debtor send the money to us. All monies received will be held in a Client Account on your behalf and sent to you after deduction of our commission and sales tax (applicable if you are an EU country).

Delete as required

* Please accept this as our authority to act on our behalf, we have read and understood the above items.

* Would you please review the attached debt information and contact me to discuss this debt.

Signed .............................................

Name ..............................................

Date ........./.............../.....................