GENERAL COLLECTION 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:

Full Legal Corporate Name:  

(including any d/b/a (doing business as) or trade names) 

Company Contact:  
Address:  
Phone, Email & Fax:  
 
  DEBTOR INFORMATION:
 
Account Number:  
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

  • Invoices

  • Statement of Account

  • Any prior checks received

  • Emails or correspondence agreeing to pay or disputing debt

  • 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.

Please validate your submission by typing the letters below into the box on the right. Letters are case sensitive.

Validation Code:

XPunbtL

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MARYLOU PAOLUCCI & ASSOCIATES, P.C.
THE CONTINGENCY LAWYERS
16 TRENT LANE, SMITHTOWN, NY 11787
Phone: (631) 863-ATTY (2889)
Fax: (631) 265-8982
Email: attycollect@optonline.net 
Website: www.ATTYcollect.com

 

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