Your voucher number
Note: if not available, please tick the box, and one will be supplied
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none
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Debtor name *
eg: Mr J Bloggs t/a ABC or ABC Limited
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Debtor trading style
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Debtor address *
If a Limited Company, enter principle place of business
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Debtor Registered Office
If a Limited Company, enter company Registered Office address
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Debtor company number
If a Limited Company, enter company registration number
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Debtor telephone number(s) *
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Debtor mobile number(s)
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Debtor email address(s)
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Currency
(indicate if other than sterling)
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Amount of claim *
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Interest 
Note: if your Terms & Conditions are not attached below, statutory interest will be added automatically.
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Contractual (ensure to attach a copy of your Terms & Conditions below)
Statutory (LPL will calculate on your behalf)
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Collection or compensation charges
Note: if your Terms & Conditions are not attached below, statutory compensation will be added automatically.
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Contractual (ensure to attach a copy of your Terms & Conditions below)
Statutory (LPL will calculate on your behalf)
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How was the debt incurred? *
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Other information
(Please enter any additional details)
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Supporting documentation
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Attach relevant documents, such as invoices, here. If you have more than 3 documents, please ZIP them up, and attach the ZIP file instead.
The total size of your attached files must not exceed 30Mb (32767Kb). To arrange bulk data transfer, please contact us.
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document 1 of 3
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document 2 of 3
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document 3 of 3
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I attach the following documents in support of this claim: *
Please send all relevant documents you feel may be useful.
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Invoices (essential) *
Credit Notes (If Applicable - Essential)
Terms and Conditions of Trading
Purchase Order Form(s)
Statement(s) of Account
Opening A/C Application Form
Copy Contract
Proof of Delivery
None - I will send all supporting documents by post or fax
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Your company name *
(If your demand is in the name of a subsidiary, enter that name and address)
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Your company email address *
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Your name *
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Your position *
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Identity documents
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For your security, we require that these documents be faxed or posted to us.
- copy of Driving License, or Passport photo page
- two utility bills - if you (the client) are a partnership or sole trader
- Certificate of Incorporation - if you (the client) are an incorporated company
We only require this information to be supplied once. If previously supplied, please tick this box:
I have already supplied identity documents.
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Declaration *
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I acknowledge an invoice for disbursements will be sent to me. *
I agree to LPL's Litigation Procedures and charges (detailed on the Litigation page) *
I certify I am authorised to issue this instruction. *
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* = required field
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