Payment Terms:

Type of Debt: (please tick)

Action Required:

(Owner’s name if not Limited)

Nature of debt:

If Yes, a special “Letter Before Action” is required setting out the various requirements of the new rules. If the requirements of the Civil Procedure Rules are not followed you may not be able to recover your costs from the debtor.

Is this debt disputed?

Your Business Name

Address 1

Address 2

City

Postcode

Your Contact Person

Company Registration Number (If known)..

Telephone

Fax

Your Email Address

Debtors Business Name

Debtors Name

Debtors Address 1

Debtors Address 2

Debtors City

Debtors Postcode

Your Account Ref.

Total Amount Due

Invoice Details     (Please follow this format: Date, Amount

C.O.D

30 Days

Net Monthly

60 Days

90 Days

Other

Goods Sold

Work Done & Materials Supplied

Services Rendered

Dishonoured Cheque

Goods Hired

Other - Please Specify

Issue a "7-Day Letter"

Issue Proceedings Immediately*

Any other information:

No

Yes

Trade Debt:

Personal Debt: