CoreLogic Transportation Services offers a nonpayment reporting service that will assist you in collecting freight charges that are past due. Upon completion of the form below, we will send on your behalf and at no charge to you, a debtor notification letter to the company you designate. This letter states that the company has been reported to CoreLogic Transportation Services for non-payment of a freight bill. This is often sufficient incentive for a delinquent account to make payment.

You will be given the opportunity to review and approve the letter prior to final submission.

Debtor Information:

Company MC#	Company Name
Street Address
City                                                                   State                 Zip
AB AK AL AR AZ BC CA CN CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT MX NB NC ND NE NF NH NJ NM NS NU NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY YK
Phone Number	Extension
	Phone format (XXX-XXX-XXXX)

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