FIDELITY RECOVERY SERVICE
5670 Schaefer Ave., Suite – O
Chino, CA 91710
(909) 902-9595 Facsimile: (909) 902-9727
Email: ron.frs@verizon.net
www.fidelityrecoveryservice.com

ASSIGNMENT FOR IMMEDIATE COLLECTION
 
DATE:
 
 
CREDITOR:


Tel.   Fax.
 
DEBTOR    ACCOUNT NO.
Address:

CONTACT PERSON


PHONE #   FAX #   CELL #
 
BALANCE $ NSF CHECK? Y N

DATE OF LAST INVOICE
DATE OF LAST PAYMENT


COLLECTION HISTORY		    
BALANCE IS DISPUTED

PLEASE INCLUDE YOUR CREDIT AGREEMENT OR

SIGNED P.O AND A RECENT STATEMENT OF ACCOUNT

OR A COPY OF THE NSF CHECK
BUSINESS IS CLOSED
AVOIDING CONTACT
DOES NOT RETURN CALLS
BREAKS PROMISES

OTHER
           

THIS IS YOUR AUTHORIZATION TO BEGIN IMMEDIATE COLLECTION AT YOUR STATED COLLECTION RATE:


AUTHORIZED PERSON
 
 


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