Application form

E-mail address* :

Are you private or business:

Private

Business

Basic information

Are you already a customer at Incassocenter?

Yes

No

Do you have funding from a private individual or a company / organization?

Private

Business

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Outstanding amount (€) * :

Your reference * :

Comments :

Add documents

Pay attention to maximum 2 MB

Larger files are best sent via Wetransfer.

List of outstanding invoices

Other relevant documents (contract, assignment, correspondence, general conditions)

An extra file

Do you want to upload more files?

No

Yes

You can send multiple files up to 2 GB for free withwetransfer.
info@incassocenter.nl can be used as an e-mail recipient.

Debtor details

Salutation

First name :

Last name :

Company name :

Contactpersoon :

Address :

Postal code :

E-mail address :

City :

Currency :

Country :

Phone number :

Mobile phone:

Salutation

First name :

Last name :

Company name :

Contact person :

Phone number :

Address :

Postal code :

Country :

Are you already a customer at Incassocenter?
Are you private or business
E-mail address
Debtor details
Outstanding amount
Your reference
Comments
Do you want to upload more files?
Do you have funding from...
Debtor details
Company name
Salutation
First name
Last name
Salutation
Contact person
Address
Postal code
E-mail address
Country
City
Currency
Phone number
Mobile phone number
Your details
Company name
Salutation
First name
Last name
Salutation
Contact person
Telefoonnummer
Address
Postal code
Country

Check if the above information is correct

You can edit them by going back to the previous page.

Yes, initiate my claim and I agree to the
Terms and Conditions and the Terms and Rates.

Yes agrees with us privacy policy agrees to the processing of your data

Signature

Reset Signature

Incasso
aanmeldformulier

Basic information

Add documents

Debtor details

Check if the above information is correct

Signature

BEL ME TERUG

BEL ME TERUG

Incassoaanmeldformulier

Application form

Basic information

Add documents

Debtor details

Check if the above information is correct

Signature

BEL ME TERUG

BEL ME TERUG

Incasso
aanmeldformulier