Please fill out the following information to send to Ohaneson & Eash, P.C. Once submitted, we will immediately begin preparing your paperwork for collecting on the debt owed to you. By submitting this form, you agree to be billed for any hourly charges incurred pursuant to your retainer agreement.

Not all boxes below will be applicable to your case, simply fill out as much information as you can. Thank you.

Contact information: Your Name / Owner of Debt / Company / Name of Authorized Agent

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Individual Owing the Debt

Please fill out this section to the best of your ability so that we can have the best chance at recovery.

Contact information: Your Name / Owner of Debt / Company / Name of Authorized Agent

What is the total amount owed to you?

Please upload a photo of the front of your driver's license.

Individual Owing the Debt

Name of the person who owes you money.

Address of the person who owes you money.

Date of Birth or Social Security Number of person who owes you money.

Phone number of the person who owes you money.

Email address of the person who owes you money.

Employer of the person who owes you money.

Any additional information which may help us in pursuing this lawsuit or serving this individual with the court paperwork. (i.e. this individual likes to go bowling on Thursdays at Strikes and Spares)

Of the total amount owed above, how much of this is late fees?

What is the account number for the defendant(s)? (If applicable)

What date was this account opened? (If Applicable)

What is the date of the last payment made by defendant(s)?

What is the address where the work was performed (if applicable)?

What was the date the work was performed? (If applicable)

Please upload the signed contract between you and the individual you wish to collect from. (If your communication was over text messages, please plan to make screenshots, and bring in copies to your appointment)

Please upload an account ledger showing payment history, dates, and amounts.

if you said Yes to the previous question, Please type your name here as your signature for the statement above.

Should our firm attempt to contact the defendant in this matter prior to filing formal litigation by email, phone, or letter?

Is the debt that you wish to collect the result of you or your company performing construction on the residence of the person who owes you money?