Legal Phone Line

765-457-9321

My Services

Account Placement Form


Client

Client ID#

Phone#

Address

State

Client Name

Fax

City

Zip

Debtor

Debtor Name

Address

State

City

Zip

Bank

Bank Name

Amount Owed

Invoice Date(s)

Account Number

Bank Information


Is This A Bad Check?
Yes   No

If Yes Please Furnish Check#, Bank Name, Amount, Date Returned, Reason Check was Returned
Check#

Bank

Reason for Return

Date


Indicate which of the following are available if needed:
Invoices?
Yes   No
Statement indicating current balance due?
Yes   No
Credit Application?
Yes   No
Contracts or Purchase Orders?
Yes   No
Copies of Checks?
Yes   No
Correspondence Concerning Claim?
Yes   No
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  • Commercial & Consumer Debt Collection
  • Estate Planning & Administration
  • Corporate law

Contact Info

Main Office
515 West Sycamore Street
P.O. Box 958
Kokomo, IN 46903-0958

Phone: 765-457-9321
Fax: 765-452-0882
Email: Brian L. Oaks