Case Information for Individual Debtor(s) - Pacific Rim Commercial Collections

Pacific Rim Commercial Collections

Case Information for Individual Debtor(s)

Please fill out the following form and submit it to Pacific Rim Commercial Collections. If available, please include Ledger (account history) and Judgment (if applicable). Thank you.

Your Name: *

Day Phone: *

Name of Creditor (if different):

Date: *

Last Name *

Defendant #1

First Name:

Defendant #1

Middle Initial *

Defendant #1

Present Address: *

Defendant #1

Does Def. Own a Bus?:

Defendant #1

Name of Business *

Defendant #1

Type of Business: *

Defendant #1

Address of Business: *

Defendant #1

Business Phone: *

Defendant #1

Contractor's License: *

Defendant #1

License No.: *

Defendant #1

Employer: *

Defendant #1

Employer Address: *

Defendant #1

Work Phone *

Defendant #1

Home Phone: *

Defendant #1

Social Security No. *

Defendant #1

Drivers License No.: *

Defendant #1

Date of Birth: *

Defendant #1

Bank Account #: *

Defendant #1

Branch: *

Defendant #1

Last Name: *

Defendant #2

First Name: *

Defendant #2

Middle Initial: *

Defendant #2

Present Address: *

Defendant #2

Does Def. Own a Bus?:

Defendant #2

Name of Business: *

Defendant #2

Type of Business: *

Defendant #2

Address of Business: *

Defendant #2

Business Phone: *

Defendant #2

Contractor's License: *

Defendant #2

License No.: *

Defendant #2

Employer: *

Defendant #2

Employer Address: *

Defendant #2

Work Phone: *

Defendant #2

Home Phone: *

Defendant #2

Social Security No.: *

Defendant #2

Drivers License No.: *

Defendant #2

Date of Birth: *

Defendant #2

Bank Account #: *

Defendant #2

Branch: *

Defendant #2

Phone