Claim Assignment

CLIENT INFORMATION

Company Name:

Client #:

Address:

City:

State: Zip:

Phone:

Fax:

Contact:

E-mail:

DEBTOR INFORMATION

Company Name:

Address:

City:

State: Zip:

Phone:

Fax:

Contact:

Home Phone:

Date of last transaction:

Excluding service charges, they owe?

When did you last speak with your debtor?

Their reaction?

Is the debtor phone working?

Bankrupt? In business?

Do you have a PO?

Credit application? Personal guaranty?

Has this file been placed for collection previously?

I understand our "Fee Arrangements" incorporated herein, I realize that if the debt is settled with money, goods, services, or canceled by my company after the assignment date, Client will be liable for Attorney Recovery Systems Inc.'s (ARS) fee, unless ARS has in writing closed this claim as uncollectible. I also understand that if after working on my file it is discovered that the debtor is out of business or been placed for collection previously, the fee may adjust according to the "Fee Arrangements" presented to Client. I am authorizing ARS to receive and endorse for the purpose of collection, any funds, in all forms received by ARS and authorize ARS to remit same to Client, less any fees due ARS. The terms of this assignment will apply to all assignments from Client to ARS, upon ARS' acceptance at ARS' corporate offices in Tarzana, California.
Signature: Date:
ARS Account Executive:
Please write any additional information you believe helpful:


   
Submit online or complete and fax to
(818)774-1601 or Outside of California (800)695-4422

National Assignment Center
Attorney Recovery Systems, Inc.
18757 Burbank Blvd., #300
Tarzana, CA 91356-6329

(818) 774-1420
(818) 774-1601 Fax
(800) 266-7248 Outside of California
(800) 695-4422 Fax