Place a Claim



Place a Claim with NACM East Coast Use this form to submit a claim - work begins within one business day! In addition to the information below, please FAX any documentation on the account to NACM Collections, 540-364-0403.

Your Name
Your Company
Address
NACM Member Number
Your Phone
Your Fax
Your E-mail
About the claim: choose a service option
	Proceed with immediate collection efforts
	Start with free demand service: no charge to you for accounts paid within 10 days of placement. Regular rates apply towards balance of claim after 10 days.

About the Debtor:
Debtor Name
Debtor Company
Debtor Address
Business Type	Corporation Partnership Sole Owner
Is this claim disputed?	Yes No
Amount Owed to You:	$ Please do not round off
Check all documentation you hold on this claim:
	Credit Application
	Invoices
	Statements
	Personal Guarantee
	NSF Checks
	Correspondence
What should we know about this claim before beginning work? Give us any pertinent comments below. (We will still contact you for instructions in most cases, but this will help us get started quickly.)
Comments

By pressing "submit" you are authorizing NACM East Coast to take immediate action as your collection agent.