Place an Account for Collection

You must be an existing client to place an account, if you are not an existing client and would like to join click here

Your Company *
Your Reference No.
Your Name *
Your Phone Number including area code *
Your Email Address *
Debtors Name *
Debtors Address *
Debtors State *
Debtors Postcode
Debtors Phone Number
Debtors Mobile
Debtors Contact Name
Debtors ABN
Debtor is a Company Business Name Individual
Debt Amount *
Currency
Date Debt Incurred: From *
Date Debt Incurred: To
Cause of Action
Action to be taken by FMC
Does your Customer Contract allow the recovery of collection expenses? Yes No
If Yes, Date of Contract
Does your contract allow for interest on overdue accounts? Yes No
If Yes, what is the Interest rate?
Do You Hold a Personal Guarantee YES NO
If your Debtor is an Individual, are we to conduct a bankruptcy search ($33) YES NO
Do you agree to FMC's Terms and Conditions in placing this account? * YES NO
Verification: