When you have an account to place, you can fill in this form and E-Mail, fax or mail the form to us. We will confirm in return that we have commenced collection activity on your behalf.
Company Name:
Address:
City: Prov/State: Postal/Zip:
Contact:
Tel #: Fax #:
Amount of Debt
PLEASE FILL IN YOUR INFORMATION:
Contact: Title:
E-Mail: