Louisiana Debt Collection Connection

The following form is designed to assist us in determining how we can best help you collect your debt(s). No client-attorney relationship or agreement of representation is created either by your submitting this form or by our email response. Only after further discussions take place, will we be in a position to provide a written contract of our representation which you must sign before we can undertake any collection efforts on your behalf.

This web page is not secure. For this reason, we do not ask for specific names, facts or details at this time, other than your name and email address for our response. We will email you as to how we feel we can assist you based on your selection of the following checkboxes. If we feel we can help you, we will make arrangements to discuss the debt(s) with you in more detail.

Alternatively, in the event of our discovering a conflict once we learn the identity of your debtor(s), we will provide you with the names of other reputable collection attorneys in Louisiana.

Please provide the following contact information:

Your Name:
Your Email Address:

Click all relevant checkboxes below to select. (If you click one by mistake, click it again to deselect.)

Which of the following types of Louisiana business entity owe you money?

Corporation
Partnership
Sole Proprietorship
Personally guaranteed

Which of the following types of Louisiana individual owe you money?
(for goods or services used primarily for personal, family or household use)

Married
Divorced
Deceased
Bankrupt

With how many accounts will you need assistance?

What is the balance of the account(s)? (Average balance if more than one)

When did you last extend credit or provide goods or services to your debtor?

When did you last receive a payment from your debtor?

Does the debtor dispute your debt?

Do you have the following information about your debtor?

Current Home Address
Current Home Telephone Number
Current Employer Name, Address and Telephone Number
Social Security Number
Driver's License Number
Other Contact Information
Current Credit Report
Notes on your collection efforts to date
Itemized billing or accounting establishing the exact amount owed

(Webmaster's note: Clicking the ‘Submit Form’ button below should take you to a Submit Confirmation Thank You page. If not, please call 1 800 380 6234.)

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