• signup@benjaminchaise.com
  • (844) 733-4770
site logo

Submit Your Account to BCA

If you’re ready to submit an account, there is certain information that we will need and find helpful to proceed with collecting your account. The best and easiest way to sign up is by calling or emailing us to walk you through the process. You could also fill out the form below.

* Required field. Please do not leave blank

Your Information

Business Name *
Field is required!
Field is required!
Your Phone number *
Invalid phone number!
Invalid phone number!
Contact Name *
Field is required!
Field is required!
Your E-mail Address
Field is required!
Field is required!

Debtor(s) Business Name/Information:

Debtor's Name *
Field is required!
Field is required!
Debtor's last known phone number(s)
Invalid phonenumber!
Invalid phonenumber!
Debtor's last known address
Field is required!
Field is required!
Debtor's last known email address
Field is required!
Field is required!

The more information you can provide about the debtor, the better the chances are of locating and collecting the debt. Some helpful information to provide includes the debtor's full company name, current and previous addresses, phone numbers, email addresses, and any additional contact information you may have. Additionally, providing documentation such as invoices, contracts, and proof of delivery can help to strengthen your case and increase the likelihood of successful debt collection. If you have any questions about the information or documentation you need to provide, don't hesitate to contact Benjamin, Chaise & Associates for assistance.

Field is required!
Field is required!
Product or Service you provided
Field is required!
Field is required!
When was the debt incurred?
Field is required!
Field is required!
Did the debtor write you a bad check?
Field is required!
Field is required!
Reason debtor gave for non-payment
Field is required!
Field is required!
When did the debt became past due?
Field is required!
Field is required!
Upload copies of documentation that supports the debt should be sent in to validate the debt. Documentation can be records, invoices, statements, bad checks, etc.
Field is required!
Field is required!
Your Message:
Field is required!
Field is required!
Submit