EXISTING CLIENTS – PLEASE READ

EXISTING CLIENTS – This form is not for you. Please logon to our portal and enter your accounts. Thank you and have a great day!

NEW CLIENTS – PLEASE READ

NEW CLIENTS – By submitting your account for collection you are agreeing to the terms and conditions as set forth below. Thank you and have a great day!

Debt

Please list all parties responsible for this debt.
Is this a medical, dental, healthcare or veterinary debt?

Debtor

Known Bad Address?

Co-Debtor

Account

(Enter the lowest settlement amount you will accept without us calling for your prior approval.)
Do you have a Personal Guarantee signed by the debtor or guarantor? If so be sure to upload a copy.

Documentation

We require supporting documentation.

Examples could include:
  • Itemized ledger adding up to the balance
  • Signed financial responsibility language
  • Signed contracts
  • Screen prints
  • Copies of driver’s license
  • Any additional supporting documentation
Select one or more files to send the required documentation:

Client

How did you hear about Secured Resolutions, LLC?

Terms & Conditions

I agree to the above Terms & Conditions
Type your full name to agree to the above Terms & Conditions: