International Commercial Collections Claim Form

Please use the Tab Key to move among fields on this claim form. Do not use the Enter Key until you are ready to submit your claim to International Commercial Collections, Inc.

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ICC CUSTOMER INFORMATION

Your Business Name:
City: State/Prov.
Country:

DEBTOR INFORMATION

Business Name:
Address:
City: State/Prov. Postal Code:
Country: E-mail:
Phone: Fax #:
Contact: Title:
Contact: Title:
(If Placed Through An Agency)
Advertiser Name:
Address:
City: State/Prov. Postal Code:
Country: Product:
Phone Fax #:
Contact: Contact:

ADDITIONAL INFORMATION:


Additional Documents to Follow?

Sending Documents By:
Mail E-Mail Fax

Invoice Dates

 Net Owed:

(month/day/year)

$

$
$
$
$
$

$

$
$
$
$
$
Total Due: $
 

In order to receive a confirmation e-mail that your claim was received and a copy of your claim, please enter your e-mail address in the space below.

Customer Contact:
E-mail:
Accompanying Files: If you have more than 20 files, please submit a second claim form.

 File 1:
 File 2:
 File 3:
 File 4:
 File 5:
 File 6:
 File 7:
 File 8:
 File 9:
 File 10:
 File 11:
 File 12:
 File 13:
 File 14:
 File 15:
 File 16:
 File 17:
 File 18:
 File 19:
 File 20:

    


No one gets hurt.
Not even their feelings.

In the vernacular, we can do this the easy way or the hard way. We do it the easy way. The way that you'll find is the easiest way to get the money owed you and normally even keep you client (or friend). We believe you should have the option. For in your business, just like our business, it all comes down to relationships and understandings.