Client Account Lodgement Form

Use this form to lodge a debt with TCS

Your Details

Trading Name

Proprietor Name (if applicable)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name

First Last

Phone

Debtors Name

First Last

Debtors Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer/Occupation (if known)

Phone

Mobile Number

Debt Amount

Date Incurred

Description of what debt is for (include invoice numbers and details)

Is this a personal or commercial debt?

Do you hold a signed Credit application for this Debtor allowing Collection costs to be Recovered? (if so please ensure these have been included)

YES

Additional Comments/Notes

TCS Client Reference (if known)

Todays Date

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