Commercial Debt Referral Form

Commercial Debt Referral Form

* Indicates a required field.


Please Do NOT enter details in CAPITAL letters - only the first letter of a word
	Do you have a contract? (Yes/No)	*
Should you not have a contract, we will require you to complete a Verbal Statement
	I confirm that this is a commercial debt. Please issue an invoice for Late Payment fees on my behalf (Yes/No)	*
	Although Late Payment fees are not vatable, please provide your VAT number for your invoice	*
SGP Client Details
	SGP Clients Name	* Your Company Name
	SGP Client Ref No	*

Debtor Details

Company

*

Title (Mr/Mrs/Ms)

*

Debtors Name (Forename & Surname)

*

Debtors E-mail

Phone (Land Line)

Mobile

Address 1

Address 2

Address 3

City

Postal

Web Site

Contact Type

Do not edit this field

Debt Details
	Date of Last Invoice (dd/mm/yyyy)	*
	Debt Amount (£)	*

	No. of Invoices Over £10k	*
	No. of Invoices Between £1k - £10k	*
	No. of Invoices Under £1k	*
Additional Details

	Is the amount disputed?	*
	Is the debtor trading?	*
	Do you have a Court Judgement? (Please give details)	*
	If yes please give details

	Please provide any other details you consider relevant

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