Cick here to download and print a Claim Placement form and mail or fax to:

Fax: (866) 696-7821

Richardson Riley & Associates
252 Carter Drive, Suite 200,
Middletown, Delaware 19709

Or fill out the following Claim Placement form for faster service.

ATTENTION
** FORM UNDER CONSTRUCTION, PLEASE DOWNLOAD FORM ABOVE OR CALL****

Creditor Information:
Company:
Date of Placement:
Contact Person/Title:
Email:
Product / Service:
Address:
City:
State/Zip:
Claim
Name:
Customer #:
DBA:
Total Claim:
Address:
Phone:
Alt. Phone:
Fax:
Email:
Invoice Number(s):
Invoice Date(s):
Date of Last Payment:
Amount of Last Payment:
Available Supporting Documentation: (Check all that apply)	Credit Application NSF Checks Purchase Order Banking Information Personal Guarantee Invoices/Statement
Additional Information:

 

If you have any questions, please email us at: moneyrecovery@richardsonriley.com