Receivables Control Corporation

Online Placement

If you would like to place claims on-line, simply fill out the form below and click the [Submit] button at the bottom. Required fields are marked with an asterisk *.

If you are not currently an RCC customer but would like more information on our collection services, please contact Jim Fritz at (763) 315-9631 or JFritz@RCCmn.com

RCC Placement	GAB Placement
RCC/GAB Client Code*:
Your Email Address*:

Debtor Information

Name*:
Address Line 1*
Address Line 2:
City*:
State:
Zip*:
Primary Phone Number*:
Alternate Phone Number:
Contact Name:
Cell Phone #:
Email Address:
Account Number:
Amount Outstanding*:
Last Invoice Date::
Last Payment Date:
Is the customer currently in business?	Yes No
Did the customer sign a credit application?	Yes No
Is there a personal guarantee?	Yes No
If yes, please attach personal guarantee:
Do you know the cutomer's excuse for not paying the debt?	Yes No
If yes, please briefly summarize:
Additional Information:

Home About Us Services On-Line Services The Team Careers Contact RCC Office: (763) 315-9600 Fax: (763) 315-9699

Home About Us Services On-Line Services The Team Careers Contact RCC

Office: (763) 315-9600 Fax: (763) 315-9699