PLACEMENT FORM
All fields with an asterisk (
*
) are required.
Accounts placed with The Stevens-Lloyd Group will be worked within 24 hours of transmission.
Your Information
Company name
*
Contact
*
Address
*
City
*
State
*
Zip
*
Country
Phone
*
Fax
Email
Debtor Information
Debtor
*
Address
*
City
*
State
*
Zip
*
Country
Phone
*
Fax
Contact person
Customer reference number
Date of last payment or invoice
Amount owed
*
Comments
Interest and collection fees will be calculated by The Stevens-Lloyd Group, Inc.
.
The Stevens-Lloyd Group, Inc.
7660 E. Broadway, Suite 106
Tucson, AZ 85710
Toll free (888)882-2282
Main (520)722-6860
Fax (520)546-1375