CLIENT ENTRANCE

NEW Under Construction

THIS WEB PAGE IS STILL UNDER CONSTRUCTION AND IS NOT FUNCTIONAL AT THIS TIME

If you have just a few accounts you may want to use the electronic submission form below.

If you have a large number of accounts, please call (337) 233-4826 so we can discuss the options available.

To submit a claim please fill out the form below and click the SUBMIT button. We will begin processing your claim right away, and contact you if we need any additional information.

You may fax or mail supporting documents such as copies of contracts and applications, or scan, attach to an email and send to: brenda@lbccinc.com   

First Time?   You Will Need To Call And Obtain A Password Prior To Placement

Name   Password  
.

CREDITOR INFORMATION

 

Business Name

Creditor Full Name

Tax ID Number

Address
City State Zip
Phone Fax Email

DEBTOR INFORMATION

 

Last Name

First Name

Middle Name

Jr-Sr

Address
City  State Zip 
Res Phone Work No Ext
Soc Sec No Date Of Birth
ID-Drivers License No Occupation

SPOUSE INFORMATION

 

Spouse Last Name

First Name

Middle Name

Jr-Sr

Res Phone Work No Ext 
Date Of Birth Soc Sec No
ID-Drivers License No  Occupation

GUARANTOR  AND/OR  OTHER RESPONSIBLE PARTY INFORMATION

 

Last Name

First Name

Middle Name

Jr-Sr

Address
City State Zip 
Res Phone Work No Ext 
Date Of Birth Soc Sec No
ID-Drivers License No Occupation

ACCOUNT INFORMATION

 

Account Number

Date Of Default

Balance Due

no  yes  Account was placed with Attorney/Collector Prior
.

 Status
Inability To Pay
Check Returned
Disputed
Mail Returned
Phone No Good
No Response
Other (specify)
..
.
.
.

Special Instructions - Notes

Account Type


BY SUBMITTING THIS FORM YOU AGREE TO THE TERMS AND CONDITIONS

Password 

or   



LBCC

Thomas Richardson

1405 MOSS STREET or PO BOX 90461
LAFAYETTE, LA 70509
(337) 233-4826 Office   (337) 234-3116 Fax
e-mail-thomas@lbccinc.com