Consumer Account Placement

Please use the form below to place an account for immediate collection. Once you have submitted the account information, we will begin the collections process immediately.

Debtor Information
Required Information

Debtor Name
Amount Owed	(we can only accept accounts of $500 or more)
Date Incurred	(date of invoice, last sale, or service rendered)
Date of Last Payment	(on delinquent account if any)
Invoice Number	(if applicable)
Address
City
State	Zip:
Home Phone
Fax
Spouse Name
Work Phone
Account Number	(if applicable)
This information will aid us in understanding your situation and your debtor. (Please check all that apply) They avoid contact (always in a meeting, out of the office, etc.) They will not return calls/messages. They dispute the bill or request additional invoices. There is a personality clash and they won't communicate with you. They broke their promise to pay sometime in the last 30 days. You made concessions and they still won't pay.
Remarks, Additional Facts, or other information

Your Information
Required Information


Client Company Name
Address
City
State	Zip:
Contact Person
Phone
Fax
Email

	Important Information Required Information
Agreement:	I/we have agreed to your terms and conditions.
Account Representative

Focus on Quality

Our services set us apart from any other collection agency. Our professional staff complies to FDCPA Guidelines and Procedures for third party debt collection. Continual training and highly motivated bilingual individuals combined, make an excellent work environment, which yields high results, commitment and attainment of collection objectives.