Claim Referral Form - Commercial Debt Collections (NYC)

Cohn & Cohn, PC. NYC Commercial Collections & Creditors Rights Lawyer - New York City Collections Attorney & Commercial Debt Collection Lawyer and Bankruptcy, Creditors' Rights, Mechanics' Liens, Small Business Law and Finance.

CLAIM REFERRAL FORM

LAW OFFICES of COHN & COHN, P.C.

CALL: (212)571-6200 FAX: (917)525-2095

Claim Referral Form - fill out and send.

* indicates required field

Date:

Your Name:

Address:

Telephone (Area Code) + Number:

Fax Number (Area Code) + Number:

Email:*

Contact Person:

E-mail:

Type of Business:

DEBTOR:

Debtor Address:

Debtor Telephone (Area Code) + Number:

Debtor Fax Number (Area Code) + Number:

Debtor Contact Person:

Debtor's Type of Business:

Amount Due:

Date Debt Incurred:

Your Reference # / Account #:

Cause of Action:

Monies had and received
Goods sold and delivered
Work labor and service rendered
Professional services rendered
Rental of equipment
Monies loaned and received
Other

If you selected "Other" please explain:

Debtor's SS# /Tax ID:

Debtor's Bank:

Bank Address:

Account #:

Other Asset Information:

Debtor's Place of Employment:

Debtor's Place of Employment Address:

Debtor's Place of Employment Telephone Number (Area Code) + Number:

CONTRACTS, RECEIPTS OR AN ACKNOWLEDGMENT OF THE DEBT IN WRITING SHOULD BE ATTACHED:

Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 1mb.

Cohn & Cohn, P.C.
100 Church Street, 8th Fl.
New York, NY 10007

CALL (212) 571-6200
Fax: (917) 525-2095

Jonathan D. Cohn
Attorney At Law
E-mail: Click here

Cohn & Cohn, P.C.
100 Church Street, Suite 800
New York, NY 10007

Request a Free Consutation

Types of Claims
Goods Sold & Delivered
Insurance Premiums
Monies Loaned
Work Labor Rendered
Services Rendered
Professional Services

Clients
Insurance Companies
Insurance Brokers
Banks
Doctors
Retailers
Manufacturers
Suppliers
Commercial Lessors
Debtors
Judgment Debtors