Collection Order

Date:

Creditor:

Client number:

Name:

Address:

Postal/zip code:

City:

Country:

VAT:

Contact:

Telephone:

Fax:

E-mail:



Debtor:

Client number:

Name:

Address:

Postal/zip code:

City:

Country:

VAT:

Contact:

Telephone:

Fax:

E-mail:



Claim:

Invoice number

Invoice date

Currency

Amount

1.

2.

3.

4.

Paid

Total:

Remarks:

We request you to send a statement of account and copy of the invoices. As the occasion arises any correspondence that has already been exchanged, copy of uncovered cheque(s) and protested bills of exchange.

In order to allow things to run smoothly, the creditor undertakes to inform ICS of any intervention on the part of debtor with regard to payment, contact or correspondence.

Commission is due in the following cases:

- Upon payment to the creditor or to ICS.

- If the creditor subsequently makes an agreement directly with the debtor to waive or cancel the debt.

- If the creditor takes back the goods.


Signature creditor :                                                                                                                        Number of pages enclosed: