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Online placements
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Current Clients
Please fill out the following fields and then skip to the debtor information section.
Client Number:
Your Name:
New Clients
If this is your first time doing business with us, please fill out the following information. You only need to fill it out once, future placements can be made simply by filling out the current client information as listed above.
Company name:
Your name :
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Country:
Phone number:
Fax number:
Debtor Information
Company name:
Contact name :
Contact Title:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Country:
Phone number:
Fax number:
Account Number:
Information About the Account
Amount Owed:
Currency:
Date of Last Sale or Service Rendered:
Invoice Number of Last Sale or Service Rendered:
Date of Last Payment:
Information About Relationship with Debtor
Please check all that apply
They avoid contact (always in a meeting, out of office, ect.)
They will not return calls or messages.
They dispute bill or request additional invoices.
There is a personality clash and they will not communicate with you.
They broke their promise to pay sometime in the last 30 days.
You made concessions and they still will not pay.
Are there any other details that you feel relavant to this account?
在您进行之前,请读我们的
服务条款
和
私隐政策
。
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