PLACE A CLAIM

  Office Address:
Law Offices of
L. Blake Morris
1214 Cortelyou Road
Brooklyn,  NY  11218-5404
Mailing Address:
PO Box 3289
New York, NY 10008-3289
Phone: (718) 826-8401
Fax: Available on request

E-Mail: info@lblakemorris.com

Home     To fax or mail your claim, PRINT this page

TYPE OF CLAIM:

Debtor Information:
       Debtor Name:
Person to Contact:
   
            Address:
                      City:     State:     Zip:-

        Area Code:    Phone: -    Fax:-

    Principal Amount Due: $. 
    Account Number that you use to identify your customer:


It is agreed that the fee for this claim will be either CLLA plus a 5% non-contingent suit fee, or alternative rate structure.  It is understood that commissions will be charged on all accounts collected, paid direct, withdrawn, or settled by the return of merchandise.

Creditor Information:
    Your company name:
       
            Your name:

                       
Address:
         
                      City:     State:    Zip:-

Area Code:  Phone:-      Fax:-   by internet: