Date Account Became Delinquent:

New Account Submission Form

*Required Field

Most Recent Date of Any Payment Received:

253-735-3200

866-499-7717

Fax: 253-333-0835

If you are an existing client, fill out the form below to place new accounts. For new clients, please contact us to setup a profile.

***As of November 2021, new federal debt collection laws require us to collect additional debt information from our clients. These new laws are intended to provide the consumer with more information upfront regarding their debt. We have modified some of the date information we collect in the form below. Please note that we now require a "Charge-off Date" in order to utilize the listing form below. If, for any reason, you cannot provide a charge-off date, please contact our office to request an alternate new account listing process. If you have any other questions, do not hesitate to contact us. Thank you for your understanding.***

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Amount Owed: *

Debtor's Bank Name:

Oldest Date of Unpaid Services: *

Debtor's Social Security Number:

Reference, Invoice or Judgment #: *

Debtor's Place of Employment:

Debtor's Date of Birth:

Debtor's Phone #:

Debtor's Street: *

Client Name: *

Client ID: *

Debtor Name: *

Reason Owed / Other:

Is this a Judgment? *

Yes

THIS COMMUNICATION IS FROM A DEBT COLLECTOR FOR THE PURPOSE OF COLLECTING A DEBT, ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.

Most Recent Date of Charges: *

Did Debtor Sign for Services? *

Yes

Debtor's City, State and Zip: *

1209 Central Ave S #210
Kent, WA 98032

Charge-off Date: *