Debtor reference form

1
PART A
2
PART B
3
PART B (Debtor)
4
PART C

1/4

PART A

Part A (Creditor / Company)

Part B (Debtor / Company )

Is the debtor an individual or a business?

IndividualReg. businessLtd. businessInc. business

Part B (Debtor)

*IMPORTANT - Does the debtor stay at the address above?

YesNoTo be verified

Birth date (yyyy-mm-dd):

S.I.N. :

Employer / Contact person:

Part C (Finance)

Billing date (yyyy-mm-dd):

Amount of the balance. :

Judgment

YesNo

Judgment date (yyyy-mm-dd):

Amount of the sentence :

Court cost :

Total amount of judgment:

Interest rate :

Veuillez laisser ce champ vide.

IMPORTANT: You must inform us and pay our commission on all payment, received by you in this file, after 24 hours of having submitted this document to Oligny-Thibodeau Collections Agency Inc. and for any reason that might explain and confirm this payment.

To pay for the opening fees, you can:

• Pay via our online shop

• By transferring your numbers, expiry date and the security code of you Visa or MasterCard via our email: collection@oligny-thibodeau.com • By calling us at 514-856-7723 at extension 0 by mentioning to our agent that you want to pay for the opening fees of your collection file