Placement Form

 

Please submit your basic information below regarding your account to start the collection process. A Service Representative will get back to you for any additional information we may need.

Your Information

Date:
Your Name:
Your Company:
Address:
City/St./Zip:
Phone/Fax:
E-mail:
Outline of Products or Services:
Debtor Information
Debtor company:
Debtor name:
Debtor address:
City/St./Zip:
Debtor phone:
E-mail:
Fax:
Amount due:
Inv #/s Date/s & Amt/s:
(optional)  Collection code:
Additional Information:

 

By clicking the above button you agree to the following: This form authorizes Account Management Systems to begin immediate collection action against the Debtor named above. Any and all payments remitted directly to you after the date entered above shall be deemed as having been collected by us, and shall incur the full applicable collection fee. If no collection is made, there will be absolutely no charge for our services. We also agrees to pay client for any monies sent to us by the debtor within 21 days of receipt of payment. All collection activities will be undertaken in accordance with all state and federal collection laws.

 

Confirmation will be Faxed, Mailed or E-mailed within 24 hours