Debt Collection Form | Professional Collection Services

Authority to Act and Debt Submission Form

Step 1 : The Authority to Act

OUR FEES

For debt collection, PCS charges a sliding commission based on the value of the debts we collect.

Please review our current commission schedule here, before continuing.

Information About You

Company / Business Name: *

ACN No:

ABN No:

Postal Address:

Business Address:

Legal Address:

Contact 1:

Contact 2:

Facsimile:

Telephone: *

Authorisation 1

I, THE UNDERSIGNED, APPOINT PROFESSIONAL COLLECTION SERVICES TO ACT AS OUR AUTHORISED AGENT TO COLLECT ACCOUNTS AND INSTRUCT THEIR SOLICITORS WHERE LEGAL ACTION IS REQUIRED. AUTHORITY IS ALWAYS OBTAINED BEFORE ANY LEGAL ACTION IS TAKEN AS THERE ARE COSTS INVOLVED.

I AGREE WITH THE TERMS AND CONDITIONS AND PRICE SCHEDULE.

I Agree to Authorisation 1: *

Authorisation 2

I FURTHER AGREE TO INFORM PROFESSIONAL COLLECTION SERVICES REGARDING ANY DIRECT PAYMENTS AND ALLOW COMMISSION AND OTHER CHARGES TO BE DEDUCTED FROM ANY MONIES HELD IN PROFESSIONAL COLLECTION SERVICES TRUST ACCOUNT ON OUR BEHALF. I AGREE THAT SHOULD THE ACCOUNT FOR COLLECTION BE SETTLED IN ANYWAY AFTER THE ACCOUNT HAS BEEN GIVEN TO PROFESSIONAL COLLECTION SERVICES FOR COLLECTION THAT THE COMMISSION AS PER THE SCALE WILL BE CHARGED.

I Agree to Authorisation 2: *

Signed (please enter your email address): *

Title Held:

Full Name: *

Date:

Please use the "back" and "next" buttons at the bottom of the form to move between pages.
Using your browser's Back button will cause you to abandon this form.

Step 2 : Accounts for Collection

Your Company / Business Name:

Your Full Name:

Your Telephone:

Signed (please enter your email address):

Debt #1

Debt 1 - Full Name of Debtor:

Debt 1 - Address

Debt 1 - Phone

Debt 1 - Your Reference No.

Debt 1 - Amount

Debt 1 - Date of Debt

Debt 1 - What account is for

Debt 1 - Any Other Info

Debt #2

Debt 2 - Full Name of Debtor:

Debt 2 - Address

Debt 2 - Phone

Debt 2 - Your Reference No.

Debt 2 - Amount

Debt 2 - Date of Debt

Debt 2 - What account is for

Debt 2 - Any Other Info

Debt #3

Debt 3 - Full Name of Debtor:

Debt 3 - Address

Debt 3 - Phone

Debt 3 - Your Reference No.

Debt 3 - Amount

Debt 3 - Date of Debt

Debt 3 - What account is for

Debt 3 - Any Other Info

Please use the "back" and "next" buttons at the bottom of the form to move between pages.
Using your browser's Back button will cause you to abandon this form.

Step 2 : Accounts for Collection - Continued...

If you have more debts to submit for collection, please enter them below.

If you are finished entering your debts, just click the "Submit" button at the bottom of the page.

Debt #4

Debt 4 - Full Name of Debtor:

Debt 4 - Address

Debt 4 - Phone

Debt 4 - Your Reference No.

Debt 4 - Amount

Debt 4 - Date of Debt

Debt 4 - What account is for

Debt 4 - Any Other Info

Debt #5

Debt 5 - Full Name of Debtor:

Debt 5 - Address

Debt 5 - Phone

Debt 5 - Your Reference No.

Debt 5 - Amount

Debt 5 - Date of Debt

Debt 5 - What account is for

Debt 5 - Any Other Info

Debt #6

Debt 6 - Full Name of Debtor:

Debt 6 - Address

Debt 6 - Phone

Debt 6 - Your Reference No.

Debt 6 - Amount

Debt 6 - Date of Debt

Debt 6 - What account is for

Debt 6 - Any Other Info

Debt #7

Debt 7 - Full Name of Debtor:

Debt 7 - Address

Debt 7 - Phone

Debt 7 - Your Reference No.

Debt 7 - Amount

Debt 7 - Date of Debt

Debt 7 - What account is for

Debt 7 - Any Other Info

You have reached the limit for number of debts that can be submitted online. Please finalise your submission for the debts you have entered, and then phone 1300 799 067 when convenient and we will be happy to obtain the details of any additional debts that you need collected.

Step 3 : Submission

By pressing submit, you are confirming your agreement with the Authorisations in Step 1 of this form (use the "back" and "next" buttons at the bottom of each page to review your information). The information you have entered will be sent to Professional Collection Services, and we will be in contact with you as soon as possible. Thank You.

Thank You

Thank you for submitting your debtor accounts for collection by Professional Collection Services.

We will review the information you have provided and contact you to advise on progress.

If you have any questions, please call us on 1300 799 067. We are happy to help in any way possible.

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Online Forms:	Authority to Act and Debt Submission
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1300 799 067

Authority to Act and Debt Submission Form