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.

    Point Law 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*

    Last Statement / Invoice Date

    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.