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Single Placement Form

Single Placement Form

Individual claims can be submitted online using the form below or simply e-mail them to newclaims@agaltd.com. If you have any questions on claim submission please be sure to contact us at (631) 719-8028.

CREDITOR INFORMATION

City
State/Province
Zip/Postal
Country

DEBTOR INFORMATION

City
State/Province
Zip/Postal
Country

PLACEMENT DETAIL

DOCUMENTATION

Please submit any contracts, notes, returned checks, itemized statements or other papers that are needed. When necessary, you are authorized to forward this account, under bond, to a commercial attorney.

Drop a file here or click to upload Choose File
Maximum upload size: 10MB

You may attach up to 5 files to this submission.
Acceptable file formats include MS Word/Excel, Apple Pages/Numbers, PDF and Zip files.

AGA LTD

NO COLLECTION. NO FEE.

  • 25% of the first $3,000 collected. 20% of the remaining balance on claims less than 365 days from last sale.
  • 50% on second placements and claims over a year from last sale.
  • 33% on international claims.
  • 25% on legal claims.
  • 35% on litigated claims - a non-contingent suit fee may be required.
  • Large claims ($100k and over) can be negotiated on a claim by claim basis.