Submitting Claim

Step 1 of 6

Your Information

Are you an Existing Customer?*

Yes

Is this debt a commercial, or business-to-business, debt?*

Yes

*** ATTENTION! - Pure Capital Group only provides commercial, or business-to-business, collection services.

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Your Company Name*

Address*

Suite/Floor

City*

State*

Zip Code*

* = Required Fields

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Your Company Name*

Your Information
Primary Contact*

Phone Number*

Email Address*

* = Required Fields

Debtor Information
Debtor Name/Business Name*

Outstanding Balance*

SSN/Tax ID

Owner/Contact Name (if business)

Phone Number

Contact's Email Address

* = Required Fields

Please upload all pertinent documentation here - contracts, statements, invoices, credit agreements, email correspondence, etc.

Drop files here or

Max. file size: 512 MB.

Additional Notes/Details

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Name (by typing your name here, you are electronically signing this submission form)*

Where did you hear about us?*
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Please tell us who referred you*

Name (by typing your name here, you are electronically signing this submission form)*

Where did you hear about us?
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Please tell us who referred you*

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Consent*
I accept the Terms of Services*
TERMS & CONDITIONS:
(a) Upon placement of any claim(s) with Pure Capital Group, they shall immediately use all necessary steps and/or resources to ensure your claim is recovered in the most cost and time effective manner possible.

(b) Client understands that commissions will be charged at a rate of 30% of any amount recovered.

(c) All payments made by debtor directly to Client shall be reported immediately to Pure Capital Group. Client understands that any payments received directly to Client after the date of placement they shall be responsible for the commission due to Pure Capital Group for their efforts in collecting said debt. Said commission shall be paid immediately to Pure Capital Group.

(d) In the event that legal assistance would be deemed necessary to progress the recovery process, Pure Capital will notify the Client and will then submit the file to their attorneys only once the Client confirms that they wish to do so.

(e) The Client will not be responsible for the hourly compensation rates of the attorneys. Rather, the 'Legal Rate' commission rate (35%) will be used upon resolution and recovery on the debt to compensate Pure Capital and the attorneys handling the case and will be deducted from any monies recovered from any settlement or judgment awarded due from Pure Capital's work. The Client will be responsible for all disbursements, filing, research, marshal, sheriff, process server, or any other 3rd party costs associated with the legal process. These costs will be due immediately as they are required along the legal process.

(f) If the client wishes, they may withdraw any claim from Pure Capital that has not yet been resolved, or that is not in the process of being resolved due to Pure Capital Group's actions whether this be with Pure Capital or with the Client directly. If a file is withdrawn outside these acceptable parameters, Pure Capital reserves the right to continue to contact the debtor involved, if necessary, to verify whether the debt has been paid after being submitted to Pure Capital. If payment for the debt was received by the client in any manner after the file was submitted to Pure Capital, then the agreed-upon commission will be due to Pure Capital immediately. If the Client wishes to withdraw a file that has previously been submitted to Pure Capital's attorneys for legal work, but before the case was settled and monies collected, the client will then be responsible for the attorney's hourly compensation rates.

(g) In the event that there is merchandise or material returned in accordance with the claim submitted, the Client will be billed for the cost of those goods.

(h) The Client will make all final decisions in the acceptance of any settlement offer made to Pure Capital or their attorneys.

(i) Pure Capital Group shall have the authority to deposit all checks into an escrow account and shall remit the balance to the Client less any fees, disbursements as set forth above, after the thirty (30) day clearance period has passed.
* = Required Fields