Allied Debt login here to submit accounts online.
Allied Debt-Mission Statement
Allied Debt Fair Dept Collection Practice ACT
Email our web site to a friend.
Allied Debt login here to submit a bankruptcy research request.
Allied Debt login here to submit a general research request.
Contact Allied Debt with this email form.

DATA FORM FOR ASSIGNED ACCOUNTS
You must be an existing Allied Debt Client to use this on-line form		  

PLEASE IDENTIFY YOURSELF AND YOUR COMPANY:
The red * indicates a mandatory field-we must have information in this field to process an account.
*Name*
*Title*
*Organization*
*Work Phone*
FAX
E-mail
*Enter your client number:*
*Choose one of the following options:*

*Enter the primary debtor's name, address and phone below:*


Enter the primary debtor's Social Security #:

Enter the primary debtor's account #:

If applicable, enter the co-debtor's name, address and phone number below: 


Enter the co-debtor's Social Security #:

 
Enter the primary debtor's employment information below: 

Enter the co-debtor's employment information below: 

If applicable, please describe your collateral.  If applicable, 
include the year, make, model and V.I.N. number:

*Enter the date of last charge or service. If this debt is based
on a loan or credit transaction, list the date of the loan: *

-- mm/dd/yy

Enter the date of last payment (if applicable) : 

-- mm/dd/yy

If debt stems from a loan or credit transaction, has the debt been charged off ?

Yes No

If debt has been charged-off, list the date of chargeoff:

-- mm/dd/yy

*Enter the exact principal amount due:*

Enter any accrued interest due and owing:

If applicable, enter the interest rate:

  If applicable, enter the date through which you have calculated interest:

-- mm/dd/yy

  Enter any collection or attorney fees due (must be allowed by contract):

  Enter any court costs due:

  Do you have a civil court judgment?

Yes No

  If you have a judgment, list all available information, including date,
court name, docket number, attorney:

  Enter any comments regarding this account:



Your account(s) will be processed the same day received.  A written acknowledgment will be mailed the same day.  Thank you for the opportunity to assist you.

 

  
Copyright © by Allied Debt Recovery Services, INC. and Crusecom Technology Consultants, LLC. All text, graphics, audio, design, software and other works are the copyright of Crusecom Technology Consultants, LLC. All rights reserved. Any distribution or reproduction of any material herein is strictly prohibited.