Simply Get Paid
Commercial Debt Referral
Do you have a contract? —Please choose an option—YesNo
Clients Name
Clients Ref Number
Company Name Title (Mr/Mrs/Ms/Other) Debtor's Name Debtor's Email Debtor's Tel (Landline) Debtor's Tel (Mobile) Debtor's Tel (WhatsApp)
Debtor's Address City Post Code
Debt Amount (£) Date of last Invoice
Number of Invoices over £10k Number of Invoices between £1k - £10k Number of Invoices under £1k
Is the amount disputed? YesNo Is the debtor trading? YesNo Do you have a Court Judgement? (Please give details) YesNo If yes please give details
What have you done to collect the debt? (Legal action/Solictor etc)
Please provide any other details you consider relevant
Please ensure that you send us your Proof of Debt documents (contract, invoices, statement of accounts, correspondence if disputed) using the drop box in the client zone or by email.