Purveyors Credit Association, Inc. – Credit & Collections Services

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Submit A Claim

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Submitting a claim is a two step process. First tell us about you and your company. Next provide us with information about the debtor.

Let's begin by you telling us about you and your company.

* denotes a required field

*Company Name

D/B/A Name

*Type of Business

*Type of Business Entity

* Type of Sales

*Address 1

Address 2

*City

*State

*Zip

*Main Phone #

Fax

*Contact's Name

Contact's Title

Contact's Phone Number

*Contact's Email Address

Contact's Fax (if different from above)

*Enter a password for your account

*Confirm the password you just entered

*Select a password reminder question

*Provide the answer to your reminder

I prefer to be contacted regarding the claims I submit via (check all that apply)

Telephone	Fax	Email	U.S. Mail