Your company name*
Please include your trading name e.g. Mycompany Limited t/a Mycompany
Debtor company registration number
Debtor contact name*
Debtor phone number
Debtor mobile number
Debt due date*
Please use the due date for the oldest outstanding invoice to determine the debt due date
Do you think this company might become insolvent in the next 3 months?
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?
What is the insured value (if applicable) GBP?
Invoice upload* max size: 10MB pdf, doc, txt, jpg, gif, png