Debt Recovery – Business Form

Fields marked with * are required

Company Name*

Company Address*

Your Name*

Your Position*

Email*

Telephone*

Nature of Company’s Business*

Name of Debtor*

Address of Debtor*

Contact Telephone Number for Debtor

Email Address for Debtor

What is the Debt Amount?*

Please provide a copy of the invoices / applications for payment

Please provide a copy of the contract / agreement / terms & conditions if applicable

If there is no written contract/agreement/ terms and conditions please provide details of what was agreed between the parties, including 1. who the agreement was with (names of individual people and positon), 2. the date the agreement was made, 3. what were the exact terms agreed and 4. how long were your payment terms.

Have you received any payment towards the invoices?*

Yes

No

If so, when and for what sum?

Do you have confirmation of the debtor agreeing to pay?

Yes

No

If so, please provide details

Is the debt disputed?

Yes

No

If so, why?

Was it a term for interest to be added?

Yes

No

If so, what % was agreed?

Please provide details of any third parties i.e. guarantors/agents

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