DEBTORS AND FRAUDSTERS REPORTING

Use the below form to report a potential Debtor or Fraudster. FDB must verify each case before we can post them to our website.

Please complete all the required fields, and we will contact you within three working days asking for specific information to verify if it is a legitimate case being reported.

Please print out and sign the Collection Authorization Letter (CAL) and return by email.

YOUR DETAILS:

THEIR DETAILS:

Company:*

Address:*

City:*

State:

Zip/Postcode:

Country:*

Owner name

Owner's email:

Contact:*

Title:

Tel:*

Fax:

Email:*

URL:*

Add More Your Contact

Add More There Contact

Contact:
Title:
Tel: *
Fax:
Email:*
Contact:
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Fax:
Email:*
Contact:
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Tel: *
Fax:
Email:*
Contact:
Title:
Tel: *
Fax:
Email:*
Contact:
Title:
Tel: *
Fax:
Email:*

Contact:
Title:
Tel: *
Fax:
Email:*
Contact:
Title:
Tel: *
Fax:
Email:*
Contact:
Title:
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Fax:
Email:*
Contact:
Title:
Tel: *
Fax:
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Contact:
Title:
Tel: *
Fax:
Email:*

DETAILS OF DEBT OWED:

Please complete the following details regarding your debt- Alternatively, leave them blank; once you submit this page, you can attach additional details. Those details would include documentation, statement of accounts, and acknowledgment of debt by the debtor/DeadBeat, as well as any communications and other such proof of debt being owed. Please include the steps you have taken to collect the debt.

Has the company you are reporting filed for bankruptcy?
Jurisdiction	Bankruptcy number:
Have you reported or filed a complaint about this company to any government agency
Name of agency:	Location:
Phone Number:	Agency file number:

Date (DD/MM/YY)*	Invoice*	Currency:*	Amount Due *

If debt is in multiple currencies, please check to ignore this section and attach Statements of Account.

Total Debt:

Currency:

Please click the browse button to the right to upload any invoices, communications, documentation or agency agreement regarding the unpaid bill/debt : (documents name can't have #,& )

Attach Invoice or Debit Note	Attach Invoice or Debit Note
Attach Invoice or Debit Note	Attach Invoice or Debit Note

If multiple attachments, please zip or email to info@FreightDeadbeats.com

* Plese validating this image