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

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