:::Welcome to Van Dinter & Associates, Inc. :::

Your Information
Your Company Name:
Your Name:
Client Number*:	*If new client, enter NEW in box
Your Customer's Information
Customer's Name:
Customer's Address:
Customer's City:
Customer's State:
Customer's Zip:	-
Customer's Phone:
Customer's Fax:
Date of Last Invoice:
Your Reference #:
Amount Owed:
Brief Explanation:
Sending proof of debt via:	E-mail: To attach to an e-mail, send to mark@vdacollect.net Fax: To send via fax, fax to (951) 693-5928 Mail: To send via mail, send to 43525 Ridge Park Drive Suite 300, Temecula, CA 92590

Placement Form