Collection Request – Deluxe Members

$0.00

Collect your childcare payment and have a check mailed directly to your center. We have a network of qualified attorneys on staff who specialize in the recovery of childcare payments.

Child Care Provider Information

Business Name *

Name of person representing the business *

Business Address *

Business City *

Business State *

Business Zip Code *

Business Phone Number *

Childcare licensing # *

Type of Operation *

Child Care Facility

In-Home Child Care

Do you have proof of debt owed? *

Please be ready to provide proof of debt at any time when needed.

Yes

Parent’s (Debtor) Information

Full Name(s) *

Current (or most recent known) Address *

Current City *

Current State *

Current Zip Code *

Parent Phone Number(s) *

SSN (optional)

Account / Invoice Number *

Balance Due / Past Due Invoice *

Describe the situation (please be detailed)

Please provide any information that we should know about the case. This can include how long they used your services, how old the debt is, or any other helpful information. Please be as detailed as possible.

Category: Legal

Description

Description

Collect your childcare payment and have a check mailed directly to your center. We have a network of qualified attorneys on staff who specialize in the recovery of childcare payments.