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EMPLOYMENT AGENCY CLAIM FORM

TO:    MARYLOU PAOLUCCI & ASSOCIATES, P.C.

16 Trent Lane

Smithtown, NY 11787

Phone# 631-863-ATTY (2889)

Fax# 631-265-8982

Email: attycollect@optonline.net


Please commence immediate suit on the usual 25% contingent fee terms:

YOUR COMPANY NAME:

Company Contact: 


Address: 


Phone, Email & Fax: 



DEBTOR INFORMATION:

Full Name of Debtor Company:  


Last Known address on File: 


Amount Now Due:   $ 

(excluding interest or finance charges)

Date of Oldest Unpaid Bill: 

Brief summary of what took place:  

PLEASE MAIL OR FAX IF AVAILABLE:

  • Any credit application
  • Any written agreement
  • Statement of Account
  • Any prior checks received
  • Any other information / any dispute


You will have an opportunity to print a copy of this form upon submission.

Please commence immediate suit on the usual 25% contingent fee terms.


You will have an opportunity to print a copy of this form upon submission.
Please commence immediate suit on the usual 25% contingent fee terms.
Please validate your submission by typing the letters below into the box on the right. Letters are case sensitive.

Validation Code:

XPunbtL

   

MARYLOU PAOLUCCI & ASSOCIATES, P.C. THE CONTINGENCY LAWYERS

16 TRENT LANE, SMITHTOWN, NY 11787

Phone: (631) 863-ATTY (2889)

Fax: (631) 265-8982

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