Submit a Claim

If you have multiple claims, please click here
Who Is Your Service Rep?*
Your Information  
Your Company Name:
Your First Name:*
Your Last Name:*
Address:*
City:*
State:*
Zip:*
Daytime Phone:*
Evening Phone:
Fax Number:
Email Address:*
Your Debtor Information  
Debtor Type:
Debtor Company Name:
*Do not use debtor place of employment for consumer claims
Debtor First Name:
Debtor Last Name:
Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Fax Number:
Email Address:
Debtor Employment:
Amount Owed:*
Date Debt Incurred:
Tax ID or SS Number:
Was there a signed Contract?  Yes No
Do You Have Backup Such As Invoices:  Yes No
Is This A Judgment:?  Yes No
If Yes, Date Judgment Was Awarded:
Product Or Service Provided:
Reason for Non-Payment:
Additional Information:

Terms of Service Agreement

THIS AGREEMENT IS MADE BETWEEN DCN HOLDINGS, INC. HEREIN REFERRED TO AS INVOICE GUARDTM AND AGENT OF _____________________ HEREIN REFERRED TO AS CLIENT.

1. CLIENT hereby engages Invoice Guard™ to handle collection of the debts and accounts placed with Invoice Guard™ under the terms and conditions stated below.

2. CLIENT agrees to pay Invoice Guard™ a monthly payment of 99.99 per month. Payments will either be made by check draft, credit card or Paypal.

3. Client can submit up to 4 accounts per month. Any unused placements within any month can be carried over to the next month. Any accounts submitted over your 4 account per month limit will be charged a one -time fee of $25.00 per account. This one-time charge will be due at the same time as your monthly 99.99 payment is due.

4. The duration of agreement will be 12 months from the date this agreement is executed, and will continue on a month to month basis until cancelled in writing. This agreement can’t be cancelled by client during the first 12 months without Invoice Guard™ consent even if they have no past-due claims to place.

5. CLIENT warrants the validity, amount and authenticity of all claims placed with Invoice Guard™ for collection. Upon request, CLIENT agrees to forward documentation to Invoice Guard™ to prove the amount, and authenticity of the claim when requested. No settlement offer is approved without CLIENT’S consent.

6. All claims placed with Invoice Guard™ by CLIENT, regardless of amount, shall be collected by Invoice Guard™ at NO COMMISSION CHARGE to the CLIENT during the first Sixty days of placement with Invoice Guard™. All Payments made by Debtor or merchandise returned by the Debtor during the first 60 days of placement will either be directed to be paid directly to the CLIENT or forwarded directly to the CLIENT immediately upon receipt by Invoice Guard™. Any claim that is forwarded to an attorney or collection network for further handling after 61 days of placement shall be billed by Invoice Guard™ to CLIENT at a rate of 20% of any and all funds collected or value of merchandise recovered by Invoice Guard™. Any claim placed with Invoice Guard™ by CLIENT that is involved in active litigation shall be billed by Invoice Guard™ to CLIENT at a rate of 35% of any and all funds collected or value of merchandise recovered by Invoice Guard™.

7.CLIENT understands that Invoice Guard™ may forward a case or a claim to an outside law firm or collection network to assist in the recovery of said account and hereby grants Invoice Guard™ permission to do so. CLIENT must give Invoice Guard™ approval in the event that such a transfer will result in an additional charge.

8. CLIENT shall report all direct payments made by Debtor to CLIENT to Invoice Guard™ within three (3) business days of receipt of payment by CLIENT.

9. Any claim that establishes a payment plan or payment arrangement within the first 60 days of placement will not be charged a contingency fee, even if the payment plan or payment arrangement exceeds 60 days of placement. If a claim is placed on a payment plan or payment arrangement within the first 60 days the CLIENT may withdraw the claim without penalty. Any claim that establishes a payment plan or payment arrangement after the first 60 days of placement will entitle Fixed Rate Collections to a contingency fee of 20%. If a claim is placed on a payment plan or payment arrangement AFTER 60 days, the CLIENT may not withdraw the claim without paying the anticipated commission due to Fixed Rate Collections. If the claim has been forwarded to an attorney in Fixed Rate Collections, Inc. network for litigation, CLIENT cannot cancel or withdraw the claim.

10. Invoice Guard™ shall account to CLIENT on a monthly basis all funds collected by Invoice Guard™ on CLIENT'S behalf.

11. CLIENT grants to Invoice Guard™ and any attorney or collection firm that Invoice Guard™ may forward CLIENT’S case to express authority to endorse and negotiate any check, draft or other negotiable instrument made payable to CLIENT for deposit in trust for distribution to CLIENT after deducting the commission and fees due Invoice Guard™ under this agreement. CLIENT specifically appoints Invoice Guard™ as its special limited attorney-in-fact to accomplish the actions of this paragraph.

12. In no event shall Invoice Guard™ be liable in any respect for the inability to collect any account placed with Invoice Guard™ by CLIENT for collection. Invoice Guard™ is not a guarantor of any specific result on accounts placed by CLIENT.

13. Invoice Guard™ shall hold harmless CLIENT from any claim, demand, action, cost or judgment, including a reasonable attorney's fee arising out of any action done or failing to be done by Invoice Guard™ in connection with the collection of any claim placed with Invoice Guard™ by CLIENT for collection.

14. This agreement shall be construed in accordance with the laws of the State of Florida. In the event that any provision hereof is found to be invalid or unenforceable, then that provision shall deemed to be severed and removed and the remaining provisions shall remain valid and in full effect.


Agree To Terms of Service

To submit an account for collection, you must agree to our Terms Of Service. By checking the box, you agree and affirm that you have read and understand our Terms Of Service and that you agree to be legally bound by those terms. This agreement applies to each and every account placed with Invoice GuardTM for collection regardless of how the account is submitted to our office. You are entering into a legally enforceable contract for the collection of the accounts submitted so do not electronically sign this document if you have any questions.

I have read and agree to all of the terms and conditions outlined in the Terms Of Service. I certify that am authorized to enter into this agreement on my behalf or on behalf of my company. I understand that this is a legal binding agreement that may be enforced through legal action. By typing my name below I am making a lawful electronic signature, capable of enforcement as if I had signed the agreement personally.

Agreed on this Date:*

Authorized Signature:*