Submit A Claim

In addition to the traditional third party collection services, LDB & Associates has developed an array of collection solutions that can be used to maintain an accounts receivable system, whether commercial or consumer.

This debtor IS LOCATED in one of the 50 United States or their territories, Canada or Puerto Rico.This debtor IS NOT LOCATED in one of the 50 United States or their territories, Canada or Puerto Rico.

Client Status *New ClientExisting Client

LDB Client No. (Existing Client)

Company Name*

Contact Name*

Address *

City *

State *

Zip Code *

Country *

Office Telephone *

Email *

Debtor Information

Debtor Company Name*

Debtor Contact Name*

Debtor Address *

Debtor City *

Debtor State *

Debtor Zip Code

Debtor Country

Debtor Office Telephone *

Account Number

Debtor is a Sole ProprietorshipPartnershipCorporation

Debtor Financial Information

Outstanding Balance *

Last Charge Date

Date of last payment

I will be submitting the following documentationStatement of AccountCredit ApplicationInvoice CopiesPersonal/Corporate GuarantyCorrespondenceBad Check Copies

Comments and/or Special Instruction

Please send a Ten (10) day Final Notice to the above debtor.

Please read the following carefully

I am authorizing LDB Associates, LLC (LDB) to commence collection action against the above debtor. LDB is also authorized to accept the debtor's payment (s) and deposit the payment (s) into their trust account on my company's behalf. I have read and accept LDB's fee schedule for this debtor.

Your Name*

What is your answer 8 x 2

Debtor Information

Debtor Financial Information

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