6355 Topanga Canyon Boulevard
Suite 255
Woodland Hills, CA 91367
T 818.360.6697
F 818.593.2180

Please accept this notice as an assignment for IMMEDIATE COLLECTION of the below account,
pursuant to your rate schedule.

Please note: attachments to this on-line placement claim form must be E-mailed
under separate cover to clientservices@ncsiweb.com

(company name or individual name)

bridging the gap between

creditors and debtors