Debtor Information
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(Please complete a separate sheet for each debtor)

Is this a consumer or business debt?  (Circle one)            Consumer          Business

Complete Debtor Legal Business Name:                                                                                                                                                                     

(Include such information as whether it is a corporation, limited liability company, or a d/b/a)

Main Debtor Contact Person:                                                                                                                                                                                                       

Complete Address:                                                                                                                                                                                                                                                              


Telephone and Facsimile Numbers:                                                                                                                                                                              

Email Addresses:                                                                                                                                                                                                                                                               

All owner’s names if a d/b/a or all known agents and contacts if a corporation or limited liability company (include addresses if available)                                                                                                                                                        

                                                                                                                                                                                                                                                                                                                                       Social Security Number(s)                                                                                                                                                                                                     

EIN (Employer Identification Number)                                                                                                                                          

Driver License Number(s)                                                                                                                                                                                                                          


Is the debtor married? ___ Yes ___ No  If Yes, full name of spouse:                                                                             

Exact Amount of Claim                                              $                                                                                                                                                                                                                                                      

How much of the Claim is Interest                         $                                                                                                                                                                                                                                                     

Amount and Date of Last Payment                        $                                                                                                                                                                                                                                                     

Please describe any personal guarantees, promissory notes, security agreements, or points of dispute with the bill.                                                                                                                                                                                                                       



Please attach copies of any written agreements, credit applications, checks written by debtor, correspondence between debtor and creditor, most recent billings sent to the debtor, and your calculation of the current balance due.  State what you are attaching:                                                                                                                                                                                                                               



Any information regarding assets, debts, employment, contractor projects, bank accounts, related business operations, etc.  Provide copies of any available documents.                                                                                                                                                                                                                              



Forwarded for Collection by:                                                                                                                                                                                                      

Contact Person Name and Telephone Number:                                                                                                                                                               

Please complete and return to:
Mark R. Mitchell
Attorney at Law
124 East Chapin Street
Cadillac, Michigan 49601
231-775-7300 Telephone
231-775-0023 Fax

Contact Us Today

If you need legal assistance collection money from a debtor, contact us to discuss your options. Call 231-577-4950 or toll-free at 866-906-3736. You can also send us an email. We will give you an honest appraisal of your case and explain how we can help you move toward a solution.