Place an Account

ONLY CURRENT CLIENTS OF WESTSIDE RECOVERY SERVICES CAN USE THIS FORM TO PLACE AN ACCOUNT.
If you are not a current client, but are in need of placing accounts for collection, please feel free to contact us by email or phone so that an account can be established.

Client ID:

Debtor Name:

Address:

City:

State:

Zip Code:

Social Security #:

Date of Birth:

Home Phone:

Work Phone:

E-mail:

 

Account Number:

Date of Service:

Balance:

Delinquency Date:

 

(For lien cases)
Attorney Name:

Address:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Is a signed copy of the lien available?
Yes  No

Last known status of case:

Comments: