ACL Adjustment Associates, Inc. - Collection Service Anywhere in the USA



Collection Service Anywhere in the USA

Use this form to submit a Consumer Collection Claim via email. An ACL representative will contact you shortly to confirm your claim and gather any additional information we may need.

Debtor Information:

Name
Account #
Address Line 1
Address Line 2
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
Claim Amount

If you need to send us any of the additional items listed below, please indicate here:

Itemized Statement of Account
Copy of Bad Check (NSF checks only)
Copy of Debtor Check (to assist in locating debtor's bank account)
Copy of Unpaid Judgement

Debtor's Social Security #:

Additional Comments:

Debtor's Work Address (if Known)

Company Name
Title
Address Line 1
Address Line 2
City
State/Province
Zip/Postal code
Country
Work Phone
FAX

Client Information:

Name

Title

Organization

Address Line 1

Address Line 2

City

State/Province

Zip/Postal code

Country

Work Phone

FAX

e-mail

Claim Submitted By (leave blank if same as client name):

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