FUEL COMPANY CLAIM FORM

TO:  MARYLOU PAOLUCCI & ASSOCIATES, P.C.
16 Trent Lane
Smithtown, NY 11787
Phone# 631-863-ATTY (2889)
Fax# 631-265-8982
 Email: attycollect@optonline.net 


Please commence immediate suit on the usual 25% contingent fee terms:

YOUR COMPANY NAME:

Full Legal Corporate Name:  

(including any d/b/a (doing business as)  or trade names) 

Company Contact:  
Address:  
Phone, Email & Fax:  
 

DEBTOR INFORMATION:

Account Number:  
Full Name of Debtor Company:  
Last Known address on File:  
Amount Now Due:   $  

(excluding interest or finance charges) 

Date of Oldest Unpaid Bill:  
Oil Delivered To:  
Repairs Made On:  
 
 PLEASE MAIL OR FAX IF AVAILABLE:
  • Any credit application
  • Any written agreement
  • Statement of Account
  • Any prior checks received
  • Any other information / any dispute

 

You will have an opportunity to print a copy of this form upon submission.
Please commence immediate suit on the usual 25% contingent fee terms.

Please validate your submission by typing the letters below into the box on the right. Letters are case sensitive.

Validation Code:

XPunbtL

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MARYLOU PAOLUCCI & ASSOCIATES, P.C.
THE CONTINGENCY LAWYERS
16 TRENT LANE, SMITHTOWN, NY 11787
Phone: (631) 863-ATTY (2889)
Fax: (631) 265-8982
Email: ATTYcollect@optonline.net 
Website: www.ATTYcollect.com

 

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