Lampert and Company Collection Claim Form

Lampert & Company - Collection Claim Form

Specializing in Collections for the Media

Creditor:

City:

State:

Debtor Business
Name

Address:

City:

State:

Zip:

Principal:

Phone:

Principal:

Fax:

Direct: In-House Agency: Agency: Buying Service:

Advertising Dates Net Amount From To $ $ $ $ $ $ Advertiser: Product: Address: City: State: Zip: Phone: Principal:

Account can be called, faxed, or mailed in. No documentation is necessary to work your account, however, if there is a known dispute or discrepancy this claim, please advise and forward all necessary documentation. Additional Information: Creditors Name:

Lampert & Company
112 SE Fort King St.
Ocala, FL 34471

Office (352) 732-4987
Toll-Free 1-800-249-1233
Fax (352) 732-4713
Toll-Free Fax 1-800-273-1436