Company /     
Location /   
 
Member # /   
State License: State Bond:
Type of Company:  Contact: 
Toll Free #:  Phone: 
Fax #:  Email: 
Web Address:  Date Founded: 
# of Office Locations:  # of Employees: 
Service States:  Service Cities/Counties: 
Associations:  Receivables Collected: 
Specialize In:  Fee Structure:
Commercial Recovery Rate %:  Retail Recovery Rate %: 
Acknowledgement Sent:  Status Report Sent: 
Remittance Report Sent:  Report Credit To: 
Client Agreement: Cancellation Clause: 
Litigation Capable: Legal Contingency Increase: 
Additional Services Offered:  Agency Comments:

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