Debt Recovery Form

Company/Landlord Name

Address

Telephone number

I / We (The Client) confirm and declare that:

You have absolute discretion in the collection of the debt or may abandon collection if the circumstances demand.
I/We will immediately advise you if payment is received by me/us in respect of any debt submitted to you. In addition I/We agree to pay, upon settlement of the debt (or part thereof) the appropriate commission, according to the following scale.
This form is used to submit debts only and the collection method will be Pre-Litigation.
FCC Paragon will not evict tenants on receipt of this form (Please contact us should you want advice on eviction).
Under £1,000: 9% + VAT
£1,000 - £2,499: 7% + VAT
£2,500 - £4,999: 5% + VAT
£5,000 or more: 4.5% + VAT

Yes I agree

Contact Title

Contact Name

Position

Full name of individual and/or trading name

Address

Telephone No.

Alternative Address (if any)

Alternate Telephone No.

Total Amount for Collection (£)

(Please complete these details below to show how this figure is calculated)

Tenancy From

Tenancy To

Monthly Rent (£)

Number of Months Outstanding

Deposit Held (£)

Please list how the dilapidations have been calculated