As always, we thank you for your business - you are our greatest asset!  Please feel free to contact us at any time.  We strive to provide innovative services to help us collect your debt and aid you in the most efficient manner.

 

What you would like to do today:

 

 

 

SUBMIT A NEW ACCOUNT:  Please complete the following form to submit a new account for collections.  For quality assurance, please fill out as much of the information as possible.  You may also submit account spreadsheets by attaching the Excel file to an email and sending it to: accounts@ffrcollects.com   Please contact us to learn about other ways to submit new accounts.

 

Please, DO NOT use the ENTER KEY on our on-line forms the ENTER KEY will close the form and submit the information uncompleted.  You may use the TAB KEY to move from field to field - thank you!

Client Information:

Name
Title
Organization
Work Phone
FAX
E-mail

Please enter your client number? 

Debtor (Responsible Party) Information:

***The organization field below is for commercial debt only.

First Name
Last Name
Middle Initial
Title
***Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please provide additional debtor information below.

First Name (required)
Last Name (required)
Middle Initial
Date of Birth
Sex Male Female
Social Security #

Debtor Employment Information: (if available)

Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX

Please enter the date of service:  (required) -- mm/dd/yy

Please enter the amount referred:    (required)

Please enter your account number for the debt: 

Please provide any additional comments below:

 

    

 

 

REPORT A PAYMENT:  Please complete the following to report any payment you have received in your office.  For quality assurance, please fill out as much of the information as possible.

Please, DO NOT use the ENTER KEY on our on-line forms the ENTER KEY will close the form and submit the information uncompleted.  You may use the TAB KEY to move from field to field - thank you!

Please provide your client number: 

Client Information:

First Name

Last Name

Title

Organization

Work Phone

E-mail

Please provide FFR's account number: 

Debtor Information:

First Name   (required)
Last Name   (required)
Date of Birth
Sex Male Female
ID Number

Please enter the amount paid:    (required)

Please enter the date of payment:  (required)  -- mm/dd/yy

Who made the payment? (the debtor, debtor's insurance, etc.)                                                     

 

Please provide any adjustment amount (if any): 

Should we consider this account settled in full (SIF)?  Yes No

    

 

REQUEST A REPORT:  Please complete the following to request a report for one of your accounts.  For quality assurance, please fill out as much of the information as possible.

 

Please, DO NOT use the ENTER KEY on our on-line forms the ENTER KEY will close the form and submit the information uncompleted.  You may use the TAB KEY to move from field to field - thank you!

Client Information:

Name
Title
Organization
Work Phone
FAX
E-mail

Please enter your client number? 

What type of Report would you like? 

Would you like another Report? 

Time-Frame:  mm/dd/yy  through    mm/dd/yy

**If you requested a Custom Report a FFR representative will contact you within 1 business day to review your specifications.

Additional Comments: