theXchange - Membership Form

Premium Collection Attorneys, Agencies and Industry Vendors from around the world.

theXchange Membership Form

Thank you for joining theXchange Global Debt Collection Network! Your membership is $495.00 per year. Please fill in all blocks and answer all questions so we can accurately record your information. To make your payment by Check or PayPal only, please click on the hyperlinks at the bottom of this form and make your payment. Once finished, click the back button to this form and complete it then press the submit button. If you have any problems, please contact us at your earliest convenience at 1-800-648-0446. We accept credit card payments and check payments via telephone also.

Email:

First Name:

Last Name:

Company:

Title:

Street Address:

City:

State/Province:

Zip Code:

Country:

Phone:

Fax Line:

Choose one of the following company descriptions:

Collection Agency Collection Attorney

Choose the "State or Country" you wish to be listed in as a collection service provider. You may list in as many states or countries as you wish. For additional state or country listings there is a charge of $50.00 per year per state or country chosen

Does your company offer any additional services? We may refer prospective clients to you for such services.

Number of years in business:

Number of offices:

Does your company fully comply with all state, federal and/or country debt collection laws?

Have you or your company ever been fined by any government agency or court of competent jurisdiction for any violation of debt collection law? If yes, please explain in the space below.

Does your company fully comply with all licensing and bonding laws in the geographic areas that you provide services for? If your answer is no, please explain below.

List company web site:

By submitting this form, I agree to and acknowledge that I have read and understood the "terms of service agreement" as well as the "disclaimer" for my membership in theXchange. In addition, I hereby authorize theXchange to verify my company information for membership in theXchange. I agree with the foregoing statement in its entirety. Yes No

How would you like to pay for your membership?

Check - please click here

Please bill me at:

Pay with PayPal

Pay by credit card:

Name on card:

Type of card:

Card number:

Expiration: (mm/yyyy)

Get connected at

800-648-0446

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