If you are a new client, please call (800) 769-6155 to establish an account and receive the FCS contingent fee schedule. Thank you.

Accounting Listing Form for Medical or Other Consumer Debt

INSTRUCTIONS: Complete the online form and click SUBMIT. You will receive a confirmation via email that your Account Listing form was submitted.

NOTE: Please understand that the information we are requesting is the same or very similar to the information required to bring this Debtor before a court. Any contact information that you have regarding debtor and/or guarantor (responsible party) will be helpful. Provide information regarding guarantors if applicable. Also, please provide any contracts, leases, patient information forms or other documentation that may permit calculation of interest, charges, fees, or other obligations for which Debtor may be responsible or about which FCS should know as your agent. Contact our office at (800) 769-6155 if you have questions.