:: Communications - Contact Form - Collection Application ::

Click Here for a Printable Version of this Form

Please fill out the form and fax it to (965) 2452590

To: The Debt Collection Department
   
Creditor
   
Name :
   
Company :
   
Civil ID :
   
Telephone Number :
   
Fax Number :
   
Post Office Box :
   
Email ID :
   
   
Debtor
   
Name :
   
Company :
   
Civil ID :
   
Telephone Number :
   
Fax Number :
   
Post Office Box :
   
Email ID :
   
Amount :
   
Age of Debt :
   
Nature of Debt :
   
Country :
   
   
   
Note :
   
   
Supporting
Documents 		: 1.
  2.
  3.
   
   
Creditor
Signature 		:
   
   
Fax : (965) 2452590
   
              

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