Subscription lettering form

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Which service do you require?
Please tick appropriate box and please make sure payment matches choice.
3 letters = €15.00 x block of 10 debtors = €150.00 3 letters = €12.50 x block of 20 debtors = €250.00 3 letters = €10.00 x block of 30 debtors = €300.00

Your details
Company Name
Date
Company Legal Status, trading as
Contact Name(s)
Phone Number
E-mail
Address

Please note: 3 letters per debtor. Blocks of 3 cannot be broken down. Service expires two years from purchase. Intrum Justitia MUST be informed immediately when debtor pays to avoid debtor receiving unnecessary correspondence.

Debtor Details
Debtor Name
Debtor Legal Status, trading as
Address
Phone Number
Mobile
Fax Number
E-mail
Your Reference
Total Amount * (please specify currency)
Oldest Invoice Date
* If this is made up of more than one invoice, please provide details of all invoice dates, numbers and amounts

Please detail actions you have already taken to date

1st Floor, Block C
Ashtown Gate, Navan Road
IE-Dublin 15
Ireland

Tel: +353 1 869 2222
Fax: +353 1 869 2244

Private Limited Company –

Reg # 175808