If you've reached this page its because this is the second debt you're registering with us.  

As with the first debt, we need some specific information from you to complete the debt registration and start collecting.  We recommend you scroll down, see what we need, and come back to finish the registration when you're ready.

As a reminder, if we collect, we charge $99 if the amount of the debt is under $1,000 or 10% of the amount collected if the debt is $1,000 or above.  If we don't collect, you don't pay anything.

Remember, if you want access to our network of lawyers and debt collectors who will collect after we send our notification letters, just check off the box at the end of the form.  If our Network Participant gets you paid, they take between 33% and 40% of what they recover plus the $99 fee.  Again, if nothing is collected, you don't pay anything.  

If you have any questions at all feel free to contact us at customerservice@indepayment.com. 

Address of person or entity that is owed money (creditor)
Address of person or entity that is owed money (creditor)
Phone number of person or entity that is owed money (creditor)
Phone number of person or entity that is owed money (creditor)
The address of the person or entity owing money (debtor)
The address of the person or entity owing money (debtor)
List as many as known
List as many as known
This address is in the United States: Yes/No (INDEPAYMENT cannot work with debts owed by non-us debtors)
The work was performed for the debtor’s personal, family or household needs
The work was performed for the debtor’s business or commercial needs
The date that you commenced work, if known
The date that you commenced work, if known
$
The date that you stopped work
The date that you stopped work
The last date the debtor made any payment (if no payment was ever made, leave blank)
The last date the debtor made any payment (if no payment was ever made, leave blank)
$
$
$
By what date should the amount of debt principal have been paid per agreement or ultimatum
By what date should the amount of debt principal have been paid per agreement or ultimatum
Do you have an agreement regarding the payment of late penalties?
$
$
Have you used a debt collector to collect this debt in the past? (attempts made by you or the creditor don’t count)
If yes, how many third party debt collectors have you used?
Have you sued to get paid?
$
Network Participants: Indepayment notifies debtors who owe commercial debts that the Account has been registered with Indepayment, and provides the debtor an option to pay. Consumer debts or and commercial debts for which the debtor is located in Alaska, Arizona, Delaware, Hawaii, Idaho, Indiana, Minnesota, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Utah, or Vermont are automatically transferred to Network Participants. For all other debts, Indepayment offers the option of sending the account to a reputable debt collector, known as a “Network Participant.” You may authorize us to send the account to a Network Participant. Doing so will increase the likelihood of collection, but will also incur additional fees upon collection because Network Participants take a portion of the amount collected as their fee. Once you elect to transfer a debt is transferred to a Network Participant, you must cease all other collection activity (other than through Indepayment).
WRITE DOWN OPTION: Indepayment and its Network Participants (if you allow us to send your debt to one) will make every effort to collect every dollar you are owed, indicated in line “AA.” However, if we are able to negotiate with the debtor we are more likely to obtain payment. You may, therefore, authorize us to “write down” the debt, meaning we accept less than the face value. Do you authorize Indepayment and its Network Participants to write down the debt to less than the amount indicated in line “AA?
$

By Registering a Debt you agree to Indepayment's Terms of Service

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