Filling the Online Claim
To submit a claim online, please complete the fields shown below. After submittiing the online claim, please ensure you send documentation identifying the debtor and substantiating the debt. This includes bills, invoices, contracts, credit application, work order(s), patient intake/financial responsibility forms, NSF check(s), drivers license and insurance cards.
Documents can be scanned and emailed to firstname.lastname@example.org; faxed to (516) 430-5015; or securely uploaded directly to our server using the file uploader. A link to the uploader can be found at the bottom of this page.
* = Required Field