Your company name* Please include your trading name e.g. Mycompany Limited t/a Mycompany
Your email* DEBT DETAILS
Debtor company registration number
Debtor contact name*
Debtor phone number
Debtor mobile number
Debtor email*
Debt due date* Please use the due date for the oldest outstanding invoice to determine the debt due date
Debtor address*
Do you think this company might become insolvent in the next 3 months? yesno
Debt value GBP* Please confirm the total debt amount including any taxes e.g.VAT, but excluding any late payment charges, these will be added by Midland Credit Control
Is this debt insured? yesno
What is the insured value (if applicable) GBP?
Additional information
Invoice upload* max size: 10MB pdf, doc, txt, jpg, gif, png