Submit a Claim
Please note, this feature is only available to current clients. If you are not yet a client
with CCS please contact us for more information about how you can become one.
Current clients, please fill in all of the fields below and click on the
"Submit" button when finished. The information will be sent to our office
and listed immediately.  
No
Please select any of the following items that you have available (select as many as apply):
Please provide us with any
additional information you
have that may help us collect
this account:
163 SE 2nd           P.O. Box 713           Hillsboro, OR 97123-0713           Ph: 503-693-1266   or   1-800-364-3089           Fax: 503-693-1630
Professional

Ethical

Effective
Consolidated Credit Services, Inc.
Debt collection and related services       1-800-364-3089
Today's Date:
Client Identification:
Client's Name:
Client's Company:
Client's Phone Number:
Debtor Information:
Debtor's Name:
Debtor's Address:
Debtor's Home Phone Number:
Debtor's Cell Phone Number:
Debtor's Work Phone Number:
Other Phone Number:
(Please specify type)
Debtor's Place of Employment:
Debtor's Bank:
Debtor's Bank Account Number:
Debtor's Date of Birth:
Debtor's Driver's Licence Number:
Debtor's Social Security Number:
Co-debtor Information (if applicable):
Co-debtor's Name:
Co-debtor's Address:
Co-debtor's Home Phone Number:
Co-debtor's Cell Phone Number:
Co-debtor's Work Phone Number:
Co-debtor's Place of Employment:
Co-debtor's Date of Birth:
Co-debtor's Driver's Licence Number:
Co-debtor's Social Security Number:
Account Information:
Principal Due:
Interest Due:
(Only if by signed contract)
Interest Rate:
(Only if by signed contract)
Fees:
(Please specify type)
Account Number:
Date of Service:
Date of First Delinquency:
Date of Last Payment:
Report to Credit Bureau?
Yes
Itemization of charges
Signed contract with debtor
Registration form / Application
Letter from debtor (disputes, promises, etc.)