YOU CAN PREPARE YOUR CLAIM RIGHT NOW!

Fill in this page, print it out, sign it and submit to our office. Once received and accepted, our staff will process the claim and queue it for immediate collection action.

Backup documentation can be emailed to us,
faxed to us toll-free at 800 871-5423
or mailed


Collection Claim Forwarding Form

 Debtor Information

Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mai l
URL

 Creditor Information

 Name
Title 
Organization 

 Amount of Claim

                               

 Bank Information

Name

 Creditors Compositions

INDIVIDUAL
PARTNERSHIP
CORPORATION - Inc. In the State of:

 Instructions to the Attorney

Submit Suit Requirments  Investigate and Advise   
File Suit Immediately    

 Basis of Claim

Merchandise  Note         Service      Contract   

 Our Experience

Broken Promises Partial Payments Stopped Payments 
NSF Checks Dispute (See Remarks) Unable to Contact
Pleads Poverty     

 Enclosures

Statements  Invoice     Note(s)     NSF Checks
Contract    Suit Costs  

 Remarks


 Forwarded By:

Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
URL
   

           I/We agree that the above claim and any other claims forwarded are upon the terms and conditions set forth below, and that I/we have retained a copy for our records.

                                                               ________________________________
                                                               (Client signature)

          Collection Lawyers hereby acknowledge this claim upon these terms.

                                                              Collection Lawyers

 

                                                              by ________________________________
                                                                   George L. Cohn
                                                                   Attorney at Law

RETAINER AGREEMENT

The within CLIENT (hereinafter referred to as "you" or "your") hereby agrees that the account(s) submitted on this Assignment Form or otherwise submitted to George L. Cohn, Attorney at Law, dba COLLECTION LAWYERS ("we", "us" or "our") are subject to the following terms and conditions.

TERMS AND CONDITIONS
1. We will handle Collection matters that we accept as defined herein for you on a contingent fee basis of forty percent (40%) of all consideration or amounts collected.
2. If you elect to file or maintain suit or a judgment or initiate or proceed with arbitration with us, you will advance to us in addition to the required costs, a sum equal to ten percent (10%) of the principal balance to be used as a noncontingent, non-refundable suit fee. These contingent and non-contingent rates are not set by law, but are negotiable between you and us.
3. A ten percent collection fee will be charged by us on all accounts where proof of a full or substantial payment to you prior to assignment is substantiated. If merchandise is returned, you will pay to us one-half of the applicable rate of collection fees, based upon the invoiced value of such merchandise.
4. If a petition in bankruptcy is filed after any collection is made and the trustee in bankruptcy successfully alleges a preferential payment, we will not be liable to return any portion of the monies collected or fees earned.
5. You authorize us to endorse and negotiate and/or deposit checks and other negotiable instruments written to you directly into our trust account and withdraw our portion of said funds. At our option, we may use any funds
collected to offset any open fees, costs and suit fees due to us on any account assigned to us for collection and/or litigation. You authorize us as your agent to forward matters to other law firms.
6. You agree to forward to us all payments received directly from debtors on assigned accounts, for deposit into our trust account; in event same does not occur you agree to pay us immediately the applicable collection fee on the said payment. The contingent rate is due to us if you or any one designated by you receive any funds or other consideration from any source by or on behalf of any person or entity against whom we are retained by you to
pursue in any Collection matter. The net funds remitted to you shall be calculated as follows: total collections minus fees earned by us and any costs. All attorney's fees awarded or recovered shall be paid to us.
7. You agree to pay us at our then prevailing hourly rates in matters or portions of matters that are not Collection matters. Such hourly rates vary with respect to the individual rendering such service and their hourly rate in effect at the time the services are performed. Attorneys' hourly rates, which are subject to periodic adjustments, are currently Three Hundred Fifty Dollars for attorneys, and One Hundred Twenty Five Dollars for law clerks, legal assistants and paralegals.
8. "Collection matters" are matters in which we seek to recover money and/or personal property for you from a third party inside the United States or Canada. They do not include defense of cross-complaints or counter-claims or separate suits against you or any third party. They do include, if necessary, filing of a lawsuit, and taking the case through trial. They do not include appeals, any work in Bankruptcy Court, injunctive relief nor provisional remedies such as applications for writs of attachment or writs of possession. They do include standard post-judgment collection efforts, including but not limited to judgment debtor examinations. They do not include any work in Probate Court, including but not limited to any prerequisite action with respect to the estate.
9. You shall be responsible for and agree to pay all costs and disbursements incurred. We may, at our sole option, advance costs and disbursements, which are immediately due. We reserve the right to require additional funds that shall be deposited in our trust account and credited to your account and shall be and constitute an advance payment against which our subsequent charges for legal fees and costs shall be debited.
10. If we withdraw or are discharged for any reason, we shall be entitled to receive from you any and all monies due and owing to us on account of legal fees incurred and/or costs advanced and/or the reasonable value of our services and/or a lien on any pending action upon which we provided collection and/or legal services. It is further we may prepare, at your expense, and retain a duplicate file with respect to all services rendered on your behalf.
11. This agreement is deemed entered into in the State of California. We are currently self-insured, and do not have an external professional liability insurance carrier. In the event of any litigation between you and us, the parties agree that (a) it can only be filed in the Superior Court located in Torrance, California, and (b) the prevailing party therein will be entitled to reasonable attorney's fees and costs incurred.
12. If this Agreement is signed on your behalf, you and the person signing on your behalf each warrant that the person signing has full authority as agent to bind you to the terms of this Agreement.
13. This Agreement may be executed in counterparts, and your signature on this or any Assignment Form or submissions of collection matters to us deems acceptance of these terms. Any copy of this Agreement shall have the same effect as an original. Submission of a claim does not mean that we will accept it. This Agreement shall become effective only after we have signed it.


2850 Artesia Boulevard, Redondo Beach, California 90278 USA
Phone 800 653-5720 Fax 800 871-5423
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