Online Intake Sheet

Note: This sheet is to be filled out per claim. A Creditor (Client) can have multiple claims against their Debtor.

To place multiple claims, please call 614-221-4129 and our office staff will assist you in this quick process.

Schiff Debt Recovey Group Client Information

SDRG Client Name*

Existing Client ID

Mailing Street Address*
City*
State*
Zip*
Suite
Claim Submitted By*
Contact Number*
Email*
Phone Number*

Debtor Information

Company Name*

Mailing Street Address*
City*
State*
Zip*
Suite
Physical Address*
City*
State*
Zip*
Suite

Company Phone Number*

Cell Phone Number

Fax Number

Date of last payment

Balance of Claim*

Date of Last Contact Attempt

Result

Where does the Debtor Bank

Description of the Debt*

Fed Tax ID/ Social Security Number

Invoice Number/Account Number*

Name of contact*

Direct Number*

History of Debtor

Check all that apply*
Debtor Has No MoneyDebtor Filed BankruptcyDebt is disputedDebtor has bounced previous checksBad Mailing AddressDebtor has been in debt with you beforeOther:

Has Debtor Admitted or Accepted in Writing to Owing This Debt?*
YesNo

Are You Willing To Sue The Debtor*
YesNo

Proof of Claim (Supporting Documents)*
Signed ContractPersonal GuarenteeCredit ApplicationStatement of AccountsInvoicesEmails/Texts/Letters stating agreementPromissory NotesCopy of ChecksOther

Add your files here:





* By selecting this box, you authorize our office to start collecting on this file, as well as agree to our terms and fee schedule.