Online Account Placement
All fields are required. If you do not have some of the information, please type an "X" in the appropriate field.
Debtor Information
Debtor Name:
Amount Due:
Currency:
Contact Name
Earliest Date of Indebtedness:
Debtor Address:
City:
Country:
Phone:
Fax:
E-mail:
Debtor HistoryBrief description of the debt and of your product/services
Claims inability to pay:
Check returned:
Disputed:
Mail Returned:
Phone Disconnected:
No Response:
Other:
Your Information
Your Company:
Your Name:
Your Address:
City:
Country:
Phone:
Fax:
E-Mail:
By submitting this form you are engaging our collection services and you agree to our terms & Conditions. Upon submitting this claim we will start our collection procedures immediately.
All fields are required. If you do not have some of the information, please type an "X" in the appropriate field.
Debtor Information
Debtor Name:
Amount Due:
Currency:
Contact Name
Earliest Date of Indebtedness:
Debtor Address:
City:
Country:
Phone:
Fax:
E-mail:
Debtor HistoryBrief description of the debt and of your product/services
Claims inability to pay:
Check returned:
Disputed:
Mail Returned:
Phone Disconnected:
No Response:
Other:
Your Information
Your Company:
Your Name:
Your Address:
City:
Country:
Phone:
Fax:
E-Mail:
By submitting this form you are engaging our collection services and you agree to our terms & Conditions. Upon submitting this claim we will start our collection procedures immediately.
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Data Recovery Associates
The Web
+ 254 20 221 1382 | + 254 712 636 404
debtrecovery@dolphinsgroup.co.ke