Faxable Form

Should you wish to fax us a placement, click on the Faxable Form button below, which will access an Adobe Acrobat PDF form that you can fill out, and fax it to us at (503) 922-0750

 Download Form

IMPORTANT NOTE: Please report to us all payments and communications with the debtor promptly. Legal action will not be instituted without your approval. Withdrawal of claims after placement may be subject to our standard fees.

CREDITOR INFORMATION
*Date:  A value is required.
*Creditor:  A value is required.
*Contact:  A value is required.
*Address:  A value is required.
*City:  A value is required.
*State:  A value is required.  *Zip: A value is required.Invalid format.
*Phone:  A value is required.
Fax: 
E-Mail:  Not a valid email.
 

 
DEBTOR INFORMATION
*Debtor:  A value is required.
*Contact:  A value is required.
*Address:  A value is required.
*City:  A value is required.
*State:   A value is required. *Zip: A value is required.Invalid format.
*Phone:  A value is required.
Fax: 
E-Mail:  Not a valid email.
*Account Balance:  A value is required.
Remarks: 
* Indicates a required field.