Submit Claim

Please proceed with immediate collection of the account listed. We agree to notify you promptly of any payments received. We agree to pay your fees on any payments made from the date of assignment forward. We understand the agency retains interest collected unless other arrangements are made. All fields marked with * are required.

Select contact:
Creditor Information
Creditor *

Contact Name *
Contact email *
Debtor Information
Debtor * 
Contact Name
Customer Number
Address *
City *
State *
Zip *
Balance Due *
Date of Last Charge *
Business Type
Corporation Partnership Individual
Collection Status *
For immediate collection 10-day free demand Choose one
You can send up to 3 documents. Maximum combinded files size 25 MBytes.
Make sure the file names do not have any characters other than letters or numbers (e.g., no ' or , or " or ) or } ).
Click on the browse button(s) to find each file on your computer.
Description 1
File 1
Description 2
File 2
Description 3
File 3
Additional Info
We will be sending the following information by mail or FAX
Invoices Itemized Statement Credit Application Other Documents
Please enter todays month and day as numbers: month / day

Please allow the computer time (about 20 seconds w/o attachments, much longer with large attachments) to process your request.
A 'Thank you Screen' will be displayed when this is done, then you can close your browser.

You authorize CCG to forward this claim to an attorney if necesssary.
No legal action will be taken without your prior approval.