Local|Toll Free
Nelson, Cooper & Ortiz

Place an Account for Collection

Submit your delinquent account online for immediate action — or download our printable form. Either way, our team gets to work fast.

Fill Out the Online Form

Complete the form below and submit directly. Our team receives it instantly and will follow up within one business day.

Go to form

Download the PDF Form

Prefer paper? Download our printable Account Placement Form, complete it, and email or fax it back to us.

Download PDF

Return completed PDF by:

[email protected] Fax: (800) 557-8195 (713) 360-6645

Account Placement Form

Fields marked * are required

Your Company (Creditor)

Debtor Information

Account Details

By submitting, you authorize Nelson, Cooper & Ortiz to contact the debtor on your behalf. No fees are charged until we collect.

NOTICE:  THIS IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. THIS COMMUNICATION IS FROM A DEBT COLLECTOR.[view & download ↗]

NOTICE:  NELSON, COOPER & ORTIZ, LLC IS A BONDED AND REGISTERED COMMERCIAL COLLECTION FIRM — NOT A LAW FIRM. WE DO NOT IMPERSONATE ATTORNEYS OR MISREPRESENT OUR FIRM AS A LAW FIRM IN ANY CORRESPONDENCE OR COMMUNICATION. WE DO NOT PROVIDE LEGAL ADVICE.[view & download ↗]