To lodge a debt claim please fill in the form below and we will be in touch shortly. CCS Client Name(Required)Contact Name(Required) First Last Email(Required) Phone(Required)Debtor DetailsName(Required) First Last Company / Business NameContact NameDate of Debt(Required) DD slash MM slash YYYY Amount Outstanding(Required)Home Address Street Address Suburb State Postcode Business Address Street Address Suburb State Postcode PhoneMobile(Required)Email(Required) Banking InstitutionEmployment StatusDate of Birth DD slash MM slash YYYY Please include any relevant paperwork(Required) Credit Application Invoices Personal Guarantee Terms of Trade Correspondence Emails Please upload relevant paperwork here(Required) Drop files here or Select files Accepted file types: jpg, pdf, png, gif, Max. file size: 128 MB, Max. files: 10. Reason for Non Payment(Required) Demands have been sent Debt is disputed Debtor skipped Business Closed Payment Promised Other Comments
