Credit Collections Bureau (CCB) - Commercial Listings

Commercial Listings

Select one^*:
Business must still be operating with a working phone number to qualify for commercial rates
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:
Since DOS / Trans Date
Payments Made^*:
Credits / Adjustments^*:
Additional Fees^*:
Interest:
*Current Placement Amount^:**

Information Pertaining to Your Business
Submitted By^*:
Send correspondence to^*:
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.