Collection Form

We process commercial credit applications only and collect business consumer debts; we do not collect for individuals.

The following form will be submitted to Borger Credit Bureau for collection.
You must agree to pay the regular collection fees whether the debtor pays you or Borger Credit Bureau.

Online Collection Form

* Indicates required field

Creditor *

Authorized by *

Debtor's Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Main Phone *

Additional Phone *

Previous Address *

Date of Birth (must be 18 or older) *

Spouse *

Social Security Number *

Spouse's Social Security Number *

Date of Service *

Amount Due *

Account Number *

Date Account was 30 Days Past Due *

Choose One *

Joint Individual

Choose One *

Debt Disputed Debt Not Disputed

After you fill out this form, submit it by clicking the Submit button.
Other options are to copy and/or print this form, and either deliver the form to us, send the form by mail, by email, or by fax.
Thank you.

Submit