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Placement Form

Please fill-out the form below and submit it electronically.
Then fax (973-256-1140), email (claims@easrecovery.com) or mail copies of invoices and various statements to:

EAS
Attn: Claims Department
P.O. Box 232
Totowa, New Jersey 07511-0232

Placement Form:
Desired Service:
(not exceeding 10 days)
Debtor's Information:
Debtor Company: *
Contact Person: *
Address:
City: *
State: *
Zip Code:
Date of Claim:
Amount: *
Account #:
Telephone: *
Fax:
Creditor's Information:
Creditor Company: *
Contact Person: *
Address:
City:
State:
Zip Code:
Telephone: *
Fax:
E-mail:
Attachment 1:
Attachment 2:

 

 

 

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