COMPANY INFORMATION Name: Address: City:    Zip code Province: Tel:        Fax:  Email: Tax/Business ID: Activity: Gross turnover: Number of employees: Contact Person: I would like to receive an answer by: Email Ordinary mail Fax  At the law firm DEBTOR INFORMATION Name: Address: City:    Zip code Province: Tel:        Amount owed: Date of the debt: Is the debt documented? Yes Private contract     Bank drafts     Delivery notes     Estimate     Miscellaneous         No               Is the debtor solvent? Yes No Do not know/No comment   Data protection policy