Collection Form

Our experienced collectors use Tarnell’s unparalleled influence in the industry to recover debts. To submit an account for collection, please provide the following information and confirm placement submission below, or complete a claim form and return to our office via email or fax.

Accept terms below after completing the form.

Debtor Information

Company Being Placed For Collection(Required)

Email Address

Address 1

Phone Number(Required)

Address 2

Home Phone

Debtor City

Fax

State / County(Required)

Mobile Phone

Zip / Postal Code(Required)

Debtor Contact Name

Creditor Information

Creditor Company Name(Required)

Creditor Contact Phone(Required)

Creditor Contact Email(Required)

Creditor Contact Fax

Collection Information

Total Placed(Required)

Date of last Unpaid Sale(Required)

Any returned checks outstanding?(Required)

Yes

Terms & Conditions(Required)

I accept the terms and conditions

Additional Notes

CAPTCHA

This field is for validation purposes and should be left unchanged.

Fee Schedule

If last unpaid invoice is less than 180 days old, the following rates will apply:

27.5% Fees on placements between $5,000 to $20,000; 22% Fees on placements $20,001 and over.
If the last invoice is between 180 days and 365 days, the fee schedule is 33%.
If the last invoice is over 365 days, the fee schedule is 50%.
If the total owed is less than $3,000, a prepaid fee may apply.

Terms and Conditions

The creditor of this claim agrees to strictly refrain from any manner of correspondence with accounts placed for collection. Tarnell reserves the right to bill for and the creditor agrees to pay costs incurred in pursuing such accounts if it is determined that such contact has taken place. Tarnell reserves the right to publish the existence of any collection matter and its status.
Accounts settled directly are subject to charges for the services as outlined in above fee schedules. Tarnell reserves the right to collect a flat 10% of the full amount of any account withdrawn. Tarnell shall have the right to endorse for deposit and collection, in the name of and on the behalf of the creditor; remittances received on accounts placed with it for collection and to deduct from such remittances its authorized charges. Tarnell reserves the right to accept or decline claims on an individual basis.