Allied National Client Login Claim Form Company Information Management Profiles Allied National Contact Us
Allied National Allied National Nationwide & International Debt Collection Services
Commercial Collections Consumer Collections Accounts Receivable Management Allied National Prompt Payment Systems International Debt Collections Services Nationwide Rent Recovery & HOA Collections Final Notice Allied National Debt Collection for Healthcare Professionals Nationwide Judgment Enforcement and Recovery
New York Office Washington DC Office Miami Office Chicago Office Omaha Office Dallas Office Los Angeles Office

Judgment Claim Form
Claim Placement Form

Complete the Form below and submit.
You will receive immediate verification of your claim placement.

If you experience difficulty submitting the claim, contact Mary Mausbach mmausbach@andc.com or 800-456-5770.

* Required fields

Subject:

Creditor Name: *

Contact Name: *

Address: *

City, State, Zip: *

Country:

Phone: *

Fax:

E-Mail: *

Debtor Information-Claim 1

Debtor Contact Name: *

Debtor Address: *

City, State, Zip: *

Country:

Debtor Phone:

Debtor Fax:

Debtor E-mail:

Debtor Cell Phone:

Debtor Social Security #:
(Consumer Claims only)

First Date of Delinquency:*
(00/00/0000)

Claim Amount: (USD) *

Attach judgment: (PDF Format)

Tell us about your case so we can conduct a case evaluation and propose a fee:

©  2010 Allied National, Inc. - TERMS OF USE - PRIVACY POLICY