Collection Authority Lodgement Form

Collection Authority Lodgement Form
Step 1
Your Details - "The Creditor"
I / We are a
Company name*
Contact person*
First NameLast Name
E-mail*
example@example.com
Business phone number
Please enter a valid phone number.
Personal phone number
Please enter a valid phone number.
Home phone number
Please enter a valid phone number.
Physical address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Postal address (fill out if different from physical)
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Bank account number*
00-0000-0000000-(0)00

Step 2
Debtor Details - "The Debtor"
Do you have a guarantor?*
YesNoUnsure
The debtor is a*
Debtor company name*
Note: You need to enter the full legal entity.
Email address*
example@example.com
Business phone number
Please enter a valid phone number.
Personal phone number
Please enter a valid phone number.
Business address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Physical home address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Postal home address (fill out if different from physical home address)
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
If you do not have a debtors address, or are unsure if the address is current, we can undertake a basic trace at a cost of $120.00+GST to try locate a current address. Do you want us to undertake a basic trace?*
YesNo

Step 4
Guarantor Details - "The Guarantor"
Guarantor's full legal name(s)*
First NameLast Name
Note: You need to enter the full legal entity. E.g "The Company" IS NOT sufficient, this needs to be "The Company Limited" OR "Joe Bloggs trading as The Company"
Employer and occupation*
EmployerOccupation
Email address
example@example.com
Business phone number
Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Personal phone number
Please enter a valid phone number.
Business address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Physical home address *
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Postal home address (fill out if different from physical home address)
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code

Step 5
Documentation
Please provide a copy of all invoice(s), statement(s), signed account application form, terms and conditions, personal guarantee(s) and correspondence or communication with the debtor(s)

A statement is required should there be more than one invoice owing.
If you do not have an account application form with terms and conditions, this significantly reduces the chances of recovery. Please send us a separate email if you would like an account application form with terms and conditions.
Select files to upload
Maximum upload size: 67MB
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