Submit Claim

Debtor Information (All information is required)
Debtor
Address 1
Address 2
City
State Zip Code
Contact Name
Telephone Customer #
Balance Due
Last Charge
Debtor Entity
Partnership Individual

Creditor Information

Creditor Name
Address 1
Address 2
City
State   Zip Code
Contact Name
Telephone
Fax
Contact E-Mail

Documentation (You can send up to 3 documents)

Description File
Click the browse button above to browse to the location on your computer.

We will be sending you the following documents via Fax/Mail:
Invoices Itemized Statement Credit Application Other
Select One:
10-Day Free Demand

Please include any comments that you deem necessary for this claims submission:





IMPORTANT:We assign the above account exclusively to you for collection. As our agent, you are authorized to proceed at once to collect the account. In the event it becomes necessary to forward the claim to an attorney for legal action, we request that you first contact us prior to such action for our authorization unless otherwise agreed. If we elect to forward the matter to an attorney American International Associates as our agent and as a convenience to us, may send the account to an attorney designated by you in the country of the debtor or, where none is so designated to an attorney whose name or firm appears in a law list publication approved by the American Bar Association or representative international agency, upon prevailing rates in the area, net to him. You or our attorneys are authorized to accept payments and to endorse checks, notes, money orders or drafts for extension. We further understand that if we authorize legal action, a suit fee or charge for legal services provided by the attorney will be made in addition to the regular collection fees. We also understand that withdrawal of this account, any payments, settlements, or return of merchandise received by us after the assigned date will be subject to regular fees.

AIA-USA.com

Contact Information

American International Associates
P.O. Box 2035
Buffalo, New York 14226
Phone: 716.707.3009
Fax: 716.829.7361
Email: bhopcus@aia-usa.com

Countries

TurkeyTurkey UkraineUkraine SlovakiaSlovakia
United Arab EmiratesU.A.E. PakistanPakistan IrelandIreland
GreeceGreece South AfricaS. Africa El SalvadorEl Salvador


ALQ     


Fax Your Request

The PDF claim submission form is available for those who prefer to fax in their claims. You may print this form down and complete it. Please be sure to include the following documents when ever a claim is submitted by fax or online:

  1. Signed Contract / agreement
  2. Purchase Order
  3. Last Statement of account
  4. Invoices
  5. E-mail correspondence

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