Doing Business with Us

Information Request

Please tell us about yourself and your organization:

Request Information

Fields in bold are required.

Organization's Name:

Your Name:

Your Email:

Phone Number:

Fax Number:

Address:

City:

State:

Zip Code:

Type of Business: Medical
Banking / Finance
Telco / Utility
Credit Card
Other:

Services You're Interested In:
(Click all that apply) Collections
Outsourcing: Extended Business Office, Early-Out
Medical Billing
Other:

Optional Information

By also answering the following questions, we will be able to answer your questions more specifically.

Type of Accounts:

Interest Bearing: Yes No

Estimated Average Account Balance ($):

Estimated Number of Accounts to be Initially Placed:

Estimated Monthly Volume ($):

Average Age of Accounts:

At what age are accounts placed? 0 - 90 days
90 - 120 days
120 - 150 days
150+ days

Have accounts been listed with another agency? Yes No

How are accounts placed? Manual Electronic Media

Frequency of placements: Monthly
Quarterly
One time focus project