Commercial Listings

Select one^*

Business Information

Business Name^*

Mailing Address

Physical Address^*

City^*

State^*

Zip^*

Phone

Main Contact Name^*

Title

Addt'l Contact Name

Title

Additional Information or Special Requests

Additional information such as credit,references, etc..

Account Information

Your Account Number For Business

Date interest figured to

Date of Service / Transaction Date^*

Principle Balance At Date Of Service

Payments Made^*

Credits / Adjustments^*

Additional Fees^*

Interest

Current Placement Amount^*

Date of last charge

Date of last payment

Interest Rate

No Interest Added

Your Business Information

Submitted By^*

(your business name)

Send correspondence to^*

(person's name)

Address^*

City^*

State^*

Zip Code^*

Phone^*

Fax

Date

Email^*

This account is assigned to you with full power and authority to perform all acts necessary for the collection and settlement of said account.

To be the best in our industry,
we have to give the best and produce the best result

Credit Collections Bureau (CCB) - Commercial Listings