Debt Referral

Fill in the debt referral form below to start your debt recovery.

Debt Referral Form.

Creditor Details

Your Company Name

Your Name

Your Email

Your Contact Number

Date Debt Submitted

Your Position

ACN/ABN:

Your Mailing Address

City/Suburb

State

Postcode

Your bank details

Account Name

BSB

Account Number

Appointment Period

12 Months 24 Months

Direct Debit Agreement

By checking this box, you understand & agree to the terms governing the debit arrangement between you & us as set out in your Direct Debit Service Agreement.

Debtors Details

Debtor Company Name

Debtor Name

Debtors ABN

Debtors Last Known Contact Number

Debtors Last Known Address

Debtors Last Known Email

Debt Details

Type of Debt

Debt Amount

Date Debt Incurred

Total Amount of Payments Made Towards Debt

Current Amount Outstanding

Attach Invoice

Details and Background of Debt

Guarantee Held?

Yes No

Debt Secured by PPSR

Yes No

Is This Debt Disputed?

Yes No

If yes, please provide details of dispute

Other Instructions

Agreement

By checking this box you have read and agree to our Terms & Conditions, Privacy Policy, and have read, understood, and agree to the terms of the Authority to Act contract below

Peace of mind starts here

Established in 2022, Binate Group’s mission is to take the fuss out of the collection process so that you can focus on the work that matters. With processes proven to collect unpaid invoices and resolve disputes efficiently, we can empower you to get what’s yours.

Binate Group Pty Ltd

ABN 33 661 474 291

Debt Referral

Debt Referral Form.

Creditor Details

Your bank details

Debtors Details

Debt Details

Peace of mind starts here

Services

Get in touch