Europäischer
Inkasso
Service
Debt collection / debt recovery order form
KS
Germany Other (Please fill out this form exactly so that we can execute your order individually)
Europäischer Inkasso Service
Phone: +49 202 94 60 50
Friedrich-Engels-Allee 216
Fax: +49 202 94 60 555
42285 Wuppertal
www.inkasso-eis.de
Germany
info@inkasso-eis.de
Debtor
:
Private person
private firm
Ltd.
Other
Unknown
Exact name:
________________________________________________________________________________________
(Companies: legal representative, private firm: owner)
Debtor’s address:
_______________________________________________________________________________________________________
Debtor’s bank account (if known):
_______________________________________________________________________________________________________
Would you like a credit check before initiating legal procedures?
Yes No
Claimed debt(s) in €: (1st, 2nd, 3rd, 4th)
____________________ ___________________ ____________________ _________________
Date(s) of invoice(s):
____________________ ___________________ ____________________ _________________
Date(s) of reminder(s):
____________________ ___________________ ____________________ _________________
Cost(s) of reminder(s)
____________________ ___________________ ____________________ _________________
Nature of demand(s): (e.g.: invoice, bill of exchange, loan, rent etc.)
____________________ ___________________ ____________________ _________________
Area of jurisdiction:
V.A.T. deductible?
Yes No
_________________________________________
Please send us copies of: orders, invoices, reminders and other helpful correspondence.
Client:
Exact name:
EIS Customer number:
_________________________________________ ___________________
Address:
_________________________________________________________________
Bank account:
_________________________________________________________________
By sending this form, I commission/instruct the European Col