Company 

Trading as

Address*

Phone Number*

Email*

Bank Number*

 -   -   -    (For debtor payments to be paid into)

DEBT DETAILS

Amount Owing $*                                                   

Invoice Number(s)                     

Date Incurred/Invoice Date       (Enter in as XX/XX/XXXX format)

Please provide a brief explanation of the reason for this debt/dispute*

Do your terms of trade have a debt collection clause*    No Yes

Upload Invoice                     

Upload Invoice                     

Upload Other Docs             

If you have additional photo's, documents, Court orders etc, please email them directly to us at admin@cia.nz  

Please click here to choose your pricing option Option 2 - Debts $500+. $69 registration fee. 25% CIA commission rate Option 3 - Debts $2,000+. No registration fee. 30% CIA commission rate Option 4 - Any debt size. No registration fee. 35% CIA commission rate  *Click here to view Pricing Options

I have read and understood CIA Debt Recovery Limited's full Terms of Engagement* 

By accepting these terms, you agree to authorise CIA Debt Recovery Ltd to act as your agent in the above matters and agree to make payment of all charges and costs in accordance with the current Terms of Engagement.

You agree to not proceed to legal action, nor take independent action by another means through an agency or, on your own accord, against this debtor without first consulting CIA Debt Recovery Ltd. 

If you do take independent action or/and if any monies are paid to you or your agent, by the debtor, CIA Debt Recovery Ltd will invoice you for the full commission that relates to the option you have chosen above and any subsequent enforcement costs.