Debt Lodgement :: Waterstone Recovery ::

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: *

	Commence debt collection (make demand for payment)
	Site visit to make demand for payment or gather information
	Issue Statutory Demand (for Registered Companies only)
	Issue Liquidation Proceedings (for Registered Companies only)
	Issue Bankruptcy Proceedings
	(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
	Terms of Trade signed by the debtor
	Credit application completed by the debtor
	Personal guarantee relating to the debt
	Emails or other correspondence with the debtor (relating to any agreements or disputes)

Required fields are marked ( * )