Client Assignments

KDCII Main Site •

This is where you tell us about yourself. Please note that all of the fields marked with * are mandatory.

Client*

Contact Name

Client Telephone*

Client Email*

This is where you fill in information about the debt you want collected. Please note that all of the fields marked with * are mandatory.

Name*

Address*

Unit/Apt. Number/etc.

City*

State*

Zip Code

Telephone

Mobile Phone

Employer

Employer Telephone

Date of Birth

Social Security Number

Amount Owed*

Date of Delinquency*

Debt Reference Number

Comments

If there are any questions please email tech@kingstondc.com.

Date	Debtor	Amount Owed	Delinquency Date	Reference