First Time Listings

As a token of our commitment to all of our new clients, we are offering a special first time collection charge. Submit your accounts using our website and collect your first delinquency.

As always, there is no obligation or charge if the account is not collected.

List an account now by filling in the form below.

You can also download a listing sheet to print and mail in to our office. (Adobe Reader required)

Listing sheet (PDF)

Listing Information

Select One^* Please SelectDirect ActionPre-Collection

Name^*

Social Security #^*

Address (last known)^*

City^*

State^* Please SelectAlaskaAlabamaArkansasArizonaCaliforniaColoradoConneticutWashington DCDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

Zip^*

Phone^*

Employer

Employer's Phone

Spouse's Information

Spouse Name

Social Security #

Spouse's Employer

Spouse's Employer's Phone

Additional Information or Special Requests

Additional Information of Special Requests

Additional information such as relative,references, patient, or if account is in judgment.

Account Information

Your Account Number For Consumer^*

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

Your Business Information

Submitted By: (your business name)^*

Send correspondence to: (person's name)^*

Address^*

City^*

State^* Please SelectAlaskaAlabamaArkansasArizonaCaliforniaColoradoConneticutWashington DCDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

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.