Debt Lodgement Form
Your Details
Company/Business Name: *
Company Address: *
Contact Person: *
Contact Number: *
Email: *
Bank Account:
(for direct credit)
Debtors Details
Legal Name: *
Trading Name: *
Postal Address: *
Contact Name:
Contact Number:
Mobile Number:
Description of goods / services supplied:
Choose the instructions you require below: *
 Make demand for payment
Issue Statutory Demand (for Registered Companies only)
Issue Summary Judgement
Issue Notice of Proceeding & Statement of Claim
Pursue Personal Guarantee (copy of guarantee required)
(Click here to view Waterstone Recovery Fees)
Debt Details
Original amount: *
 $
Amount paid: *
 $
Amount outstanding : *
 $ Click to calculate Amount outstanding
Please indicate which of the following you have and upload them with this form when you submit the debt for collection: *
 Invoices for the debt
Emails or other correspondence with the debtor (relating to any disputes or agreements)
Terms of Trade that was sent to the debtor before the goods or service was provided.
Terms of Trade signed by the debtor before the goods or service was provided
Personal Guarantee over the debt
Required fields are marked ( * )