Fast Track Debt Collection PTY Limited ("FTDC")

Appointment of Collection Agent

You the Client hereby appoint Fast Track Debt Collection PTY Limited ("FTDC") as collection agent from the date of this Debt lodgment.
You the Client hereby agree to our Collection Service Agreement Terms & Conditions which apply to and are incorporated into this Debt lodgment. [These terms and conditions are available on our website and on request].
The person lodging this Debt matter warrants that he/she is authorized to submit this lodgment and is authorized to accept our Collection Service Agreement Terms & Conditions

Please Note: We are only permitted under the Act, to recover what has been Tax Invoiced to the Debtor.

:: Your Details
:: Please fill out your details below.
Name/Company Name:
Trading Name:
ABN:
ACN:
Trustee of Trust:
Your Address:: Line 1:

Line 2:

City:

Country:

State:

Postal Code:
Phone:
Mobile:
Email:
:: Your Bank Details
:: All funds recovered are Direct Deposited to your Nominated Account below.
Name of Bank:
Account Name:
BSB:
ACC Number:
:: Debtor Details
:: Please fill out the debtor details here.
YOUR REF:: (Invoice/Account Number)
INV DATE:: (Oldest Inv)
INV DATE:: (Most Recent)
TOTAL OWING:: (Of combined invoices, if more then one)
DEBTOR NAME:: (Company name or persons name owing the debt)
DEBTOR CONTACT:: If a business.
DEBTOR PHONE:
DEBTOR MOBILE:
Debtor Email:
DEBTOR POSTAL ADDRESS:: Line 1:

Line 2:

City:

Country:

State:

Postal Code:
DEBTOR STREET ADDRESS:: Line 1:

Line 2:

City:

Country:

State:

Postal Code:
DEBTORS ABN:
Click to attach copy of invoice/s. (Please Attach all invoices to single pdf):
Click to attach copies of supporting docs. (Please attach all invoices to single pdf):
Spam Verification: