Claim Placement

Placing an account with Slovin & Associates, LPA has never been so easy! Take a moment to complete the collection placement form below and we will contact you as quickly as possible.

    Debtor Information

    Debtor Name *

    SSN *

    Address *

    City *

    State *

    Zip *

    Amount Due ($) *

    Debtor's Bank *

    Your File # *

    Home Phone *

    Work Phone

    Fax

    Mail returned? *

    Email *

    Debtor History - Please Check All That Apply *

    Please include any additional information in the box below

    Creditor Information

    Full Name *

    Title *

    Company Name *

    Address *

    Phone *

    Fax

    Email *

    Terms and Conditions

    This claim placement form and all information included on this web site, including the submission of this form, do not create an attorney-client relationship between you and Slovin & Associates Co., LPA, nor is it intended to do so. We reserve the right to accept or decline representing any person or organization in any matter. Before we can represent you, we must make sure that doing so will not create a conflict of interest. Do not send via e-mail any confidential or privileged information about any legal matter that may involve you until we have decided to represent you. You will receive an acknowledgement from one of our attorneys and at that time, you will be our client, and we may exchange confidential information freely. As always, you may contact us by phone at 513-683-9000 to discuss any potential claim you may have.