416.844.3682
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info@nccservices.com
COMMERCIAL ACCOUNT PLACEMENT FORM
Debtor Name or Trade Name:
Legal Composition of Debtor:
Sole Proprietor
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Partnership
Other
Debtor Address Information:
Debtor Telephone Number:
Debtor Fax Number:
Debtor email address:
Reason for non payment:
Reason for non payment:
Date of Last Transaction:
Balance Due:
Documentation to Follow by:
Mail
Fax
Email
Invoices:
Copy of Account:
Pertinent Letters:
Credit Application:
Recent Statement of Account:
Contract and Notes on File:
Creditor Contact Name:
Creditor Telephone Number:
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NCCS - National Credit and Collections Services
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