Fidelity Creditor Service, Inc.

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Submit Accounts for Collection

Online Account Referral Form

By submitting an account for collection, you agree to the terms and conditions of our Collection Agreement. Please link to the Agreement Page for more information.

Fill out the form below, being as complete as possible and provide any additional information that may be useful in assisting us to collect your account. Please note: fields marked with a red asterisk "*" are required to process your submission. If you do not have information for one of these fields, type "none".

For your convenience you may wish to bookmark this page for future submissions.

Your Information:

*Company Name			*Date
*Your Name
*Address			*City
*State			*Zip
*Phone			*Fax
*Email
*Type of business, product or service
*How did you find us?

Debtor Information:

*Debtor Name
Co-Debtor Name
*Amount Due
Interest Rate
*Date of Last Pmt
*Last Service/ Delinquent Date
Address			City
State			Zip
Phone			SS#
Date of Birth
Invoice Ref. #
Co-Debtor SS#
Co-Debtor DOB
Employer
Address			City
State			Zip
Phone
Terms or Conditions of Sale
Additional Information or Comments

Type of Account:

Select as many items below as apply:

Credit Card NSF Check	Medical Auto Loan	Retail Commercial	Personal Loan Judgment
Other:


Corporate Offices 216 S. Louise Street Glendale, California 91205 or PO Box 3963 Glendale, California 91221 Toll Free 800.440.1981 Telephone 818.502.1981 Fax 818.502.1979 info@fcscollect.com	Ventura Branch Office 4587 Telephone Road, Suite 212 Ventura, California 93003 or PO Box 7599 Ventura, California 93006 Toll Free 888.440.1981 Telephone 805.477.7447 Fax 805.650.0790 ventura@fcscollect.com
Home • Company Profile • Submit Accounts • Transfer Accounts • Collection Rates • Handling Litigation • Fully Computerized • Outperforming Collection Averages • Sophisticated Skiptracing • Friendly Client Service • Links Page • Testimonials Copyright © 2002 Fidelity Creditor Service, Inc. All Rights Reserved. FIDELITY CREDITOR SERVICE and its logo design are trademarks of Fidelity Creditor Service, Inc. All other trademarks are copyrighted by their respective owners. Site design and maintenance by Design Strategies, Inc.