Assign Accounts

NCC Recovery, Inc.

is dedicated to a fast, secure and efficient method of placing your delinquent accounts for collections. Please fill out the form below as completely as possible. If a required field does not apply to your account you can put “NA” in the field and continue. Please TAB between fields. DO NOT

communicate with the debtor unless you coordinate it with the collector or supervisor handling the account. IMPORTANT:

Once a file is placed for collection the back-up documentation should be mailed or faxed to our office; we do not need originals.

* REPORT THIS ACCOUNT TO CREDIT BUREAU?

* Debtor Last Name (as you want it reported to Credit Bureau)

* First Name (as you want it reported to Credit Bureau)

SS#

Spouse/Co-Debtor

Spouse/Co-Debtor SS#

* Street Address

* City

* State

* ZIP

Home Phone

Work Phone

* Original Contract Date (admit date)

* First Delinquency Date. (When did they go past due?)

* Amount Assigned for Collection

* MAP Account?

Interest Rate (if applicable)

Additional Information
(i.e. other phone #’s, addresses, relatives, contacts, insurance info, other responsible parties, discharge date, ect. Provide us with any information that may assist us in collection)

* Date Submitted for Collections

* Company Submitting Claim

* Your Phone #

* Your Email (to send you a confirmation of this account)

* Authorized by

* I/we agree to terms of contract on file with NCC Recovery
 Check Box to agree

* Indicates Response Required

For more information please contact us toll free at (866) 577-0057 or email us at:

info@nccrecovery.com

NCC Recovery…Collection and Debt Recovery Specialists

Are you looking for a ? NCC Recovery is a Nationwide in California. For more information on a Full Service contact NCC Recovery.

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