Debt Collection Form

If you would like our Debt Collection Team to collect your debt(s) please complete the form below. Fields marked with a * must be completed.

Your Details:

Please enter your email address
Which office is convenient for you? is required

Debtors Details:

Please enter the debtors email address
Please enter if the debt disputed

Before you become a client of Birkett Long, we may send you information by email about our services that we believe will be of interest.

Birkett Long’s privacy policy can be found here.

Please enter the verification code