Marine Debt Management - Full Service Quotation Form

MARINE DEBT MANAGEMENT
Rivington House 82 Great Eastern Street London EC2A 3JF
Tel: 020-7362 0220 Fax: 020-7362 0227

FULL SERVICE QUOTATION/INSTRUCTION FORM

Name of Sender

Position

Name of Company

Date

PART A: Please quote for collection of the following debt.

Name of Debtor

Address

Vessel (if any)

Amount of debt

Due date

Statement attached? YES / NO

Debt disputed? YES / NO

Remarks

PART B: Our fees in respect of recovery of the above account.

Handling Charge

Commission

Commission is calculated on the amount by which the debt is reduced after we receive your instructions. Should the debt remain unpaid you only pay the Handling Charge.

If you wish us to proceed, kindly complete PART C below and return the completed form to us. This quote remains valid for two weeks.

for MDM

Date

PART C: Instruction to proceed with collection activities.

We accept your above quotation for recovery of the debt set out in PART A and hereby instruct you to proceed with collection activities. We undertake to notify you of all payments and/or communications sent and received in respect of this debt.

Signed

Date

Marine Debt Management Limited
Registered in England No. 3028664 at the above address

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PART A: Please quote for collection of the following debt.
Name of Debtor
Address
Vessel (if any)
Amount of debt	Due date
Statement attached? YES / NO	Debt disputed? YES / NO
Remarks

PART B: Our fees in respect of recovery of the above account.
Handling Charge	Commission
Commission is calculated on the amount by which the debt is reduced after we receive your instructions. Should the debt remain unpaid you only pay the Handling Charge.
If you wish us to proceed, kindly complete PART C below and return the completed form to us. This quote remains valid for two weeks.
for MDM	Date

PART C: Instruction to proceed with collection activities.
We accept your above quotation for recovery of the debt set out in PART A and hereby instruct you to proceed with collection activities. We undertake to notify you of all payments and/or communications sent and received in respect of this debt.
Signed	Date