Case Submissions - Johnson Morgan & White

Please describe the mission you wish us to accomplish::

Client Information:

Date:

Client Number:

Client Name:

Client Email address:

Authorized By:

Debtor Information:

Company Name:

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Country:

Tel. No. (Primary)

Tel. No. (Secondary)

Fax No.

Client Reference #:

Contact Name / Title:

Email Address:

Website:

Last Payment Due:

Earliest Inv. Date

Amount Due:

Personal Guarantor:

Guarantor Street:

Guarantor City:

Guarantor State:

Guarantor Zip Code:

Guarantor Tel. No.:

Documentation To Follow:

Please click as many as you wish:

Invoices
Contract
Credit Application
NSF (Checks)
Itemized Statement
Notes

Comments:

Submitting this information to our office authorizes Johnson, Morgan & White (JMW) to initiate collection proceedings on Client's behalf. Client agrees to be liable for the agreed upon contingency fee pending collections. Client authorizes JMW to receive, endorse, and deposit into JMW's Trust Account, any and all checks issued in Client's name. JMW will remit funds to Client after deduction of its fees.

6800 BROKEN SOUND PARKWAY BOCA RATON, FLORIDA 33487
PHONE: 800.441.9550 FAX: 800.501.9338
PHONE: 561.241.2500 FAX: 561.241.2510
JMANDW.COM
©2008 JOHNSON MORGAN & WHITE FORENSIC COLLECTIONS SPECIALISTS