First Name                               

Last Name                                

Business Name                        

Address                         

Telephone number                                      

E-mail                                      

 

 

Debtors name                        

Debtor address            

Contact name                        

                         Telephone number                

Business                            

Mobile                                

Invoice reference                  

Invoice date                         

Invoice amount                    

Current debt amount            

Add late payment fee to outstanding debt                 

Add mycash collection fee to outstanding debt         

I have read and accept mycash terms and conditions

When you submit this debt for collection mycash will e-mail confirmation to you at the above address with a request for you to reply to this e-mail to confirm you wish mycash to act. In some cases we may also telephone to discuss the debt in more detail before proceeding..