henriksen limited : New Debt Information

Please fill out the following form to register a new debt you wish us to collect. If you would rather fill out the form manually and post it to us, please click here for a PDF version.

Questions in bold are required in order to process the form.

Contact Details for Debtor

What is the name of your business?(required)
What is your business' phone number?(required)
Who owes you money? Please provide a full name and address of the debtor owing the money. If it is a business, please also provide a contact name that you have dealt with, where possible.(required)

Telephone number of the debtor

Fax number of the debtor

Email address of the debtor

Debt Details

Details of the debt. Please tell us what it relates to, e.g. repairing burst pipes February.

Your invoice or reference number

Invoice date or loan date

Original balance

What is the balance outstanding at today's date?(required)

Date of the last payment

Amount of last payment (£)

Additional Details

Please confirm you have advised your customer in writing that this debt is being referred to a debt collection agency and that fees will be added. Please write either Confirmed Yes or Confirmed No in the box opposite.

If this debt is disputed in any way, please provide details.

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Once we receive this debt, we will contact you within 24 hours.

Carlisle House, Carlisle Street, Goole, East Yorkshire DN14 5DS

Telephone: 0845 4130502 E-Mail: info@henriksen-limited.co.uk Fax: 01405 780764

New Debt Information

New Clients

Existing Clients