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 Money Debtor Filed Bankruptcy Debt is disputed Debtor has bounced previous checks Bad Mailing Address Debtor has been in debt with you before Other:

Has Debtor Admitted or Accepted in Writing to Owing This Debt?*
 Yes No

Are You Willing To Sue The Debtor*
 Yes No

Proof of Claim (Supporting Documents)*
 Signed Contract Personal Guarentee Credit Application Statement of Accounts Invoices Emails/Texts/Letters stating agreement Promissory Notes Copy of Checks Other

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.