Online Account Placement

The Debt Recovery People ::

Account Placement Form

Company Name:*		Client Acct #:*
Representative Signature:*		Date:*
The representative ensures all information below is accurate to the best of his/her knowledge and agrees to provide Sentry Risk Solutions, LLC with any information on the account which would change the delinquency status or accuracy of the account information provided.
Customer Detail Information:
Customer Name:*
Address:		City/State:*
Zip Code:		Home #:
Work #:		Alternate#:
Employer Name/City:		Spouse Name:
		Spouse Employer:
Account Detail Information:
Debtor’s Acct#:*		Date Delinquency Occurred:*
Date of Service:*		Total amount due:*
Interest/Fees Due:*
Returned Payment:	Yes No
Disputed Account:	Yes No
Returned Mail:	Yes No
Comments: