THE KAIGHN COMPANY PLACEMENT FORM

* - Denotes a required field
Our Company: *
Contact Person: *
Our Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone: *
Fax:
E-mail: * 
We wish to place the following claim with you at your established rules and rates:
Debtor Name:
Debtor Contact:
Debtor Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:
Amount of Claim:
Debtor Composition:
Comments or Special Instructions including invoice dates & amounts:
(Hard copies to be mailed or faxed (800-992-9121) along with credit application and other pertinent documentation.)
 
 

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