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First Time Listings

As a token of our commitment to all of our new clients, we are offering a special first time collection charge. Submit your accounts using our website and collect your first delinquency you list with us for only 27%.

As always, there is no obligation or charge if the account is not collected.

List an account now by filling in the form below.

You can also download a listing sheet to print and mail in to our office. (Adobe Reader required)

Listing sheet (PDF)

 

Select one:	Select One Direct Action Pre-Collection
Name:	*
Social Security #:
Address (last known):	*
State:	*
Zip:	*
Phone:
Employer:
Employer's Phone:
Spouse's Information
Name:
Social Security #:
Spouse's Employer:
Spouse's Employer's Phone:
Additional Information of Special Requests
Additional information such as relative, references, patient, or if account is in judgment.
Account Information
Your Account #:
Principle Amount:	$
Date Last Charge:
Interest/Other Charges:	$
Total to collect:	$*
Information Pertaining to Your Business
Submitted By: (your business name)
Send correspondence to: (person's name)
Address:
City:
State:	Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other / Canada
Zip Code:
Phone:
Fax:
Date:
Email:
This account is assigned to you with full power and authority to perform all acts necessary for the collection and settlement of said account.