Create your account

Please note! All fields marked with an asterisk (*) have to be filled in.

I am a: Organization Consumer     The definition of a 'company' is that in the broadest possible meaning. Examples are: commercial companies, governmental organizations, etcetera.
Organization name *
Legal form *
Chamber of Commerce registration
Salutation    Sir Madam
Initials *
Insertion   
Last name *
Address *
Zip code / City *
Zip code / City *
Country *
Phone *
Mobile   
E-mail address *
Bank account number *
BIC code *
IBAN *
Bank name *
Bank location *
VAT-liable * Yes No VAT-liable.
If you are a consumer or company not located in The Netherlands, please fill in no.
Remarks  
   

Submit your claim

Outstanding amount of your claim *
Phone number(s) of your debtor
Email address of your debtor
Contact with your debtor
Is a written contract available Yes No
Have you previously outsourced this claim Yes No
Has a court procedure already taken place? Yes No
Do you have a verdict? Yes No
Do you know if your debtor has any other debts? Yes No
Select your Terms and Conditions if/where applicable
Select your agreement here
In the absence of a written agreement, please provide additional information that allows us to determine your claim has been established.
Other files such as invoices, email messages and other correspondence. Select file 1...
Upload another file... Additional information
   

E-mail confirmation

• Thank you your reaction.
• We will consider all information delivered and reply to you on a short term.
• If we need any other information, we will contact you.