United Commercial Collections

To: United Commercial Collections
Please proceed with immediate collection of the account listed. We agree to notify you promptly of any payments received. We agree to pay your fees on any payments made from the date of assignment forward. We understand the agency retains interest collected unless other arrangements are made.

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Debtor Information (All information is required)

Debtor

Address 1

Address 2

City

State

Zip Code

Contact Name

Telephone

Customer #

Balance Due

Last Charge

Debtor Entity

Corporation

Partnership

Individual

Creditor Information

Creditor Name
Address 1
Address 2
City
State			Zip Code
Contact Name
Telephone
Fax
Contact E-Mail

Documentation (You can send up to 3 documents)

Description	File

Click the browse button above to browse to the location on your computer.

We will be sending you the following documents via Fax/Mail:
Invoices Itemized Statement Credit Application Other
Select One:

For immediate Collection

10-Day Free Demand

Please include any comments that you deem necessary for this claims submission:

IMPORTANT: You authorize United Commercial Collections to forward this claim to an attorney if necessary. No legal action will be taken without your approval.

United Commercial Collections | 4455 Genesee Street | Buffalo, NY 14225
Ph (716) 250-4600 | Toll Free (866) 234-4610 | Toll Free Fax (888) 856-3972
info@uccollections.com • www.uccollections.com