Load Commercial Debt

Load Commercial Debt

Fields marked * are mandatory fields

YOUR DETAILS
Company Name	Trading As
Contact Person*	Contact Email*
Address*	Email for Statements*
Mobile*	Landline
Bank Account Number* - - -

DEBTOR DETAILS
Company Name*	Trading Name
Company Email	Company Website Address
Company Phone	Company Social Media Profile
Current Company Address
Contact Person	Contact Person's Position
Contact Person's Phone	Contact Person's Email
Other information on this debtor that may help with collecting the debt?
Upload Photo of Debtor

DEBT DETAILS
Do you have a Court or Tribunal Order?* Select Yes or No above to reveal the relevant fields.
Amount Owing $*	Date Incurred / Invoice Due Date	Court Order Date*
Invoice / PO Number(s)	Court / Tribunal CIV Number*	Do your terms of trade have a collection provision * No Yes I Don't Know	Court Location*
Your Debt Reference
Reason Debt / Dispute*
Upload Copy of Unpaid Invoice(s)	Upload Other Supporting Documents

DEBT COLLECTION AGREEMENT
Choose a debt collection Pricing Option
Custom Radio Buttons Option 1 - Only available if you have an agreement with CIA Debt Recovery for special pricing Option 2 - Debts $500+. $69 debt loading fee. 25%+GST flat-rate fee Option 3 - Debts $1,000+. No debt loading fee. 30%+GST flat-rate fee Option 4 - Any debt size. No debt loading fee. 35%+GST flat-rate fee Pricing Information We charge a flat commission fee (rate) based on a percentage of the total debt amount that you have instructed us to collect. Our total commission fee is not charged upfront, unless the debtor repays the debt immediately in full with one payment. If your debtor pays the debt under a repayment plan, our commission fee is deducted in small portions from any payment(s) instalments received towards the debt. This policy maximises the collection outcome for you because we only earn our commission when recovery of the debt starts. ×
Download, sign, and upload this Authorisation to Act on Behalf: (click the PDF icon to download) Court policy requires you to confirm CIA Debt Recovery will be your debt collection agent acting on your behalf.
Terms of Engagement By accepting these terms, you agree to authorize 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 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.
I have read and understood CIA Debt Recovery's full Terms of Engagement *
How did you hear about us? If you have trouble with this online form you can download the PDF form here and send the completed form to debts@cia.nz

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