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SINGLE CUSTOMER
10 DAY FREE DEMAND ASSIGNMENT FORM
Complete and submit this form to initiate 10 Days Free Demand.
Pacific Southwest Credit Association will utilize the information and send a "demand letter" to your customer will be granted a 10 day window to pay the balance that is owed. The service is free if the full balance is paid within the 10 calendar days. If the full balance is not paid within 10days, the account will "roll over" and convert to full service collection account which will be subject to regular contingency rates. Free demands are not subject to cancellatiom.
 
Member Number:  Required  
 
1 - Please provide Debtor Information.
Debtor Name:  
Account No:  
Contact Name:  
Address:  
Address2:  
City:  
State:  
Zip Code:  
Country:  
Work Phone:  
Fax Number:  
Email Address:  
 
Debtor Entity:           
 
Please use the space below to give us the Name(s), Home Address(es) and Home Phone Numbers of any Owner, Partners, Corporate Officers:
 
 
 
 
 
 
 
 
Date of Last Charge:   (mm-dd-yyyy)  
Last Date Finance Charge or Interest Charge Added:   (mm-dd-yyyy)  
Date Last Payment Received:   (mm-dd-yyyy)  
 
Balance Due:   Required  
 
Which of the following will you be sending us to help collect this debt?
 
                                
                                
                                
 
Please add any comments you may have about this debt and/or debtor that would help us collect this balance for you:
 
 
Claim assigned on rates effective October 1, 1992. This account may be forwarded to attorneys for collection. Legal action will not be filed without authorization.
 
 
2 - Please provide information about the creditor.
 
Submitted By:  
Email Address: Required  
Phone Number:   (xxx-xxx-xxxx)