Claim Submission • Williams, Charles, & Scott LTD.

The filling out of this placement form and the submission of same constitutes a contract between your office and Williams, Charles & Scott LTD. (hereafter known as WCS). Please click here to view our Terms & Conditions document. If you are submitting consumer claims, please contact our sales department first: sales@wcscollects.com.

* Required field

Placement Form

Your Company Information

Name

Organization

Street Address

City

State

Postal Code

Phone Number

Fax Number

Your Customer's Information

Contact Name

Organization

Street Address

City

State

Postal Code

Telephone

Fax

Amount $

Date of Last Invoice

Comments

Attach supporting documents from your computer or submit other documentation via email to placements@wcscollects.com or fax to 631-462-5751

Select Your Supporting Documents

If you were referred by a friend, please enter your referral code below

I have read and agree to Williams, Charles & Scott, LTD.'s TERMS & CONDITIONS of placement.

Total size should be below 40MB. If you have larger files or more than five files, you can use this function multiple times and use the comments section to let us know this is part of the same submission.