SUBMIT A NEW ASSIGNMENT
- Online Account Referral Form -

Fill out the form below, being as complete as possible and provide any additional information that
may be useful in assisting us to collect your account.

Please note: fields marked with a red asterisk "*" are required to process your assignment. If you do
not have information for one of these fields, type "none".

For your convenience please bookmark this page for future assignments. Early assignments and
plenty of information produce the best results.
Please call (888) 860-2950 if you do not
know your client code
*Client
Code :
*Date :
*Your EMail:
Main Debtor Information
*Main Debtor's
Name:
*Debtors Adds:
*Debtors City:
*Debtors State:
*DebtorsZip:
Cel Ph:
HomePh:
SS#:
Date of Birth:
Main Debtor's
Employer Name:
Work Ph / Ext:
Please provide information on the Co-Debtor if the Co-Debtor is a Spouse, Co-Signer, Parent or the owner of
the Company (if the Main Debtor is a Company).
Co-Debtor:
Co-Debtors
SS#:
Co-Debtors
Date of Birth:
Cel Ph:
HomePh:
Relationship to
Main Debtor:
Work Ph / Ext:
Account Information
*Date of Last Payment/
Charge or Service:
*Amount Due:
CONSUMER / RETAIL
 COMMERCIAL
 BAD CHECK
 COURT JUDGMENT
Additional Information about the account or the Debtor

Free NATIONAL
Credit Bureau
Reporting


Spanish Speaking
Collectors


Fully Commission
Based


No Collection
Means
No Charge


Full Service Legal
Department


Full Service
Skip-Tracing and
Asset Location


No Start-Up or
Membership Fees


Medical


Dental



Property
Management



Bad Checks



Judgments



Tuition Fees



Open Invoices



Broken
Service
Agreements



Leases

Direct Credit Control, Inc.
269 S Beverly Drive - Ste 439
Beverly Hills, California 90212
Tel: (888) 860-2950 - Fax: (310) 861-1818
"A Professional Full Service Collection Agency"
DCC