Online Account Placement

All fields are required. If you do not have some of the information, please type an "X" in the appropriate field.

Debtor Information

Debtor Name:

Amount Due:

Currency:

Contact Name

Earliest Date of Indebtedness:

Debtor Address:

City:

Country:

Phone:

Fax:

E-mail:

Debtor HistoryBrief description of the debt and of your product/services

Claims inability to pay:

Check returned:

Disputed:

Mail Returned:

Phone Disconnected:

No Response:

Other:

Your Information

Your Company:

Your Name:

Your Address:

City:

Country:

Phone:

Fax:

E-Mail:








By submitting this form you are engaging our collection services and you agree to our terms & Conditions. Upon submitting this claim we will start our collection procedures immediately.


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Data Recovery Associates
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Persuasive, Persistence, Professionalism
+ 254 20 221 1382 | + 254 712 636 404
debtrecovery@dolphinsgroup.co.ke