Application – European Debt Recovery


                                  
                                    
                                  
                                    
                                      Your Details
                                      Section 1

                                    
                                    
                                      
                                      
                                    
                                    
                                      Name*
                                      

                                    
                                    
                                      Company
                                      
                                    
                                    
                                      Address
                                      

                                    
                                    
                                      Country
                                      
                                    
                                    
                                      Tel
                                      
                                    
                                    

                                      Fax
                                      
                                    
                                    
                                      Email*
                                      
                                    
                                    

                                      RMI
                                       

                                        If you are a member of 
the RMI select yes

                                        Membership number 
                                    
                                  

                                      Details of the debt
                                      Section 2
                                    
                                  
                                    
                                      
                                      
                                    

                                    
                                      Please collect the following debt on our behalf
                                    
                                    
                                      Debtor Name
                                      

                                        Exact Trading Name If
                                        Possible     

                                    
                                    
                                      Your Ref No. 
                                      
                                        (if applicable)
                                    
                                    
                                      Address

                                      
                                    
                                    
                                      Tel
                                      
                                    
                                    
                                      Fax

                                      
                                    
                                    
                                      Email
                                      
                                    
                                    
                                      Type
                                        Of   Approach

                                      
                                    
                                    
                                      Debt
                                        Amount (Please state currency)
                                      
                                      
                                    

                                    
                                      Age Of Debt
                                      months
                                    
                                    
                                      Additional
                                        Information 
                                      

                                    
                                    
                                      Invoice  Number   
                                      
                                    
                                    
                                      Date
                                      

                                    
                                    
                                      Amounts
                                      
                                    
                                    
                                      
                                      

                                    
                                  
                                      Upload
                                      Section 3
                                  
                                  
                                      
                                  
                                  
                                      Please attach any relevant files.
                                  
                                  
                                      
                                      
                                       
											
											
       
             


    
      
                                      
                                      
                                      
                                      
                                      
                                  
                                  

                                      
                                  
                                  
                                      
                                  
                                     
                                      Submit
                                        Application
                                      Section 4
                                    
                                    
                                      
                                    

                                    
                                      To submit 
your debt placement form please click the send button below. Once the information 
has been reviewed by one of our debt specialists we will contact you to discuss the 
application in detail.
                                    
                                    
                                      
                                         I have read the terms & conditions 
                                    
                                    

                                      Fields marked * are required

Your Details	Section 1

Name*
Company
Address
Country
Tel
Fax
Email*
RMI	If you are a member of the RMI select yes Membership number
Details of the debt	Section 2

Please collect the following debt on our behalf
Debtor Name	Exact Trading Name If Possible
Your Ref No.	(if applicable)
Address
Tel
Fax
Email
Type Of Approach
Debt Amount (Please state currency)
Age Of Debt	months
Additional Information
Invoice Number
Date
Amounts

Upload	Section 3

Please attach any relevant files.



Submit Application	Section 4

To submit your debt placement form please click the send button below. Once the information has been reviewed by one of our debt specialists we will contact you to discuss the application in detail.
	I have read the terms & conditions
Fields marked * are required