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Prushka Online Action Form

If you hate forms, call us on 1800 641 617 and we will gladly take your debt details on the phone.
You only need to complete your details once.
Step1: Complete details  Step2: Acknowledge our trading terms  Step3: Submit
*Compulsory FieldsPrint This Page
Are you a: *
Debtor: *
Your Email Address: *
Date of first invoice: *
Balance Owing: * $
Details of service or goods provided by you: *
Add Prushka Commission to the Debt? *

(Only select option if your trading terms allow you to do so. Call Client Services Team to explain further)
(Maximum characters: 3900)
You have characters left.
Do you have an Attachment? *
Yes No
Please Note: To assist with collection, we need a copy of the invoice for the debt.
Please attach any relevant Information:
Please Note: Please limit to a file size of maximum 1MB with 4 attachments
I confirm that the above details are true and correct and that I agree to be bound by
Prushka's Terms and Conditions.
Name: *
Typing your name above constitutes your signature
Position: *
State Position if Signing on behalf of a business

Please type what you see:

Enquiries - Call the Prushka Client Services Team - Freecall 1800 641 617
One Form only.
After you have submitted this form, you don't need to complete forms for other debts. Just email, fax or post copies of all other overdue accounts to us.
Post: Private Bag 6, Mitcham, Victoria, Australia 3132
Fax: (03) 9872 4757