I understand that this application neither obligates me to Legally Enforce Revenue nor does it obligate Legally Enforce Revenue to me.

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APPLICATION FORM

NOTE: All fields are required.

Case number (if known): Amount of judgment:
 
Amount collected to date: Date judgment was issued:
/ /
State in which judgment was issued: County in which judgment was issued:
 
Were you represented by attorney?: Judgment awarded by default? (defendant not present?):
Debtor now residing in different state?: Name of debtor:
Last known street address of debtor: Last known city of debtor:
Last known state of debtor:
Last known zip of debtor:
PERSONAL INFORMATION  
Full name: Telephone number:
Email address: City:
Street address: State:
Zip:
Description of my case (please be brief but thorough):
Copy of judgment (please make selection):

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Legally Enforce Revenue Est. 2008