Debt recovery details form

What is the name of your company or business? Please type the name as it appears on your invoices.

What is the ABN of the company or business

The person completing this form - should we need to contact you

What is your principal place of business?

What is the name of Debtor? Please type the name of the Debtor as it appears on the relevant invoice.

What is the ABN of the Debtor?

What is the name of the person from the Debtor who you primarily deal with?

What is their email address?

What is the last address of the Debtor you have on your records? Make sure this is the last address they have asked you to use for them.

What is the registered address of the Debtor if you know it? Leave this blank if you don't know.

What is the amount currently owing?

What was supplied to the debtor:

How many invoices are outstanding?

Was a quote provided?

Were quotes provided? Answer for each invoice "yes" or "no"

What was the date the quote or estimate was provided?

For each invoice what was the date of the quotes provided? Use the format " / / "

What was the amount invoiced?

For each invoice what was the amount invoiced (including GST)

Date on your invoice

For each invoice what was the date of the invoice? Use the format " / / "

Your invoice number - leave blank if none

What was your invoice number or each invoice? Leave balnk if none.

Date payment became due according to your standard trading terms

What are your standard trading payment terms? eg "14 days"

Did you agree to extend your standard payment terms?

What was the date the goods or services were supplied? If supplied over a period, type "../../.. to ../../.."

For each invoice, when were the goods or services supplied? Use the format " / / " or If supplied over a period, type "../../.. to ../../.."

Describe the goods or services provided. Show as they appear in your invoice if possible, or summarise if there were numerous items on the invoice or invoices.

If goods were delivered to, or services provided at a particular address - state that address - eg "delivered by Courier Services to 103 Ingham Road, Townsville" or "construction work undertaken at 103 Ingham Road, Townsville". Leave blank if not applicable or you are not sure.

Show any payments that have been made. Include the amounts and dates paid. Leave blank if none.

What reminders you have sent? eg. "Statement sent 31/5/17" or "monthly statements since 31/5/17".

Has the Debtor disputed the amount owing or has there been any other dispute over the goods or services provided?

If the Debtor has disputed the amount owed, outline what they said, who said it and when.

Has there been any correspondence with the Debtor about payment other than standard reminders?

Outline any correspondence you have had with the Debtor about the debt (other than reminders).

Has there been any payment arrangement or extensions of time to pay, agreed to with the Debtor?

If you agreed to any payment arrangement or additional time to pay, provide details and whether there was any part complaince. Leave blank if none.

Which of the following do you want us to send?

Please upload the contract or terms and conditions applicable to this debt.

Please upload the relevant invoice/s

Please upload a copy of the quote or estimate

Please upload copies of any correspondence with the Debtor

If there is any other documentation you think is relevant - please upload it here.

If there is anything else you think is relevant or we should know about?