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Download a Claim Form

In order to commence the evaluation of your claim, we request that you fax or send the following information along with a completed copy of our downloadable claim form:

  1. Statement of account invoices, payments and credits applied.
  2. Copies of each invoice which is reflected on your statement of account.
  3. Copy of any check that you receive from the debtor (your bank keeps copies of all checks that you deposit).
  4. A signed credit application (if available).
  5. A signed personal guaranty (if available).
  6. A copy of any written contract (if available).
  7. Any correspondence between you and your customer about the debt.
  8. An invoice or delivery slip containing your business terms.

Besides the information listed above, please download and print our claim form below.

Click here to download our claim form in Adobe Acrobat (PDF) format (72KB)

All paperwork, along with the completed copy of the claim form should be faxed to 201-875-3074 or sent via the mail to:

The Law Offices of Joseph A. Molinaro
648 Wyckoff Avenue
Wyckoff, NJ 07481

The use of the Internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

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Complimentary Claim Review

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