Firm *

Address *

Phone

Submitted by *

Email *

Standard approved rates as follows: We make no charge until the payments or agreed settlements are received by you - or by us - then we divide one-half to you and one-half to us, unless otherwise specified in the Collection Agreement. Rates are based on volume and frequency of assignment. Any interest collected on open accounts is to be retained by Credit Bureau Associates in lieu of listing, docket, tracing, Court or Sheriff's Fees. In the event judgement is entered and interest is recovered, each interest, together with court costs advanced by us, will be applied out of first monies collected. The accounts below are assigned to Credit Bureau Associates with full authority thereon to bring action or suit, and to do any and all things necessary to enforce collection of said claim.

List all pertinent information The more complete the information, the quicker the collection
Full name and address of responsible party (MR., MRS., MISS., JR., SR.)

 

Debtor's Name		SSN#
Address		City
State		Zip
Phone		Mail Ret'd
Account #		Amount Owing
Date of Last Charge		Date of Last Activity (Payment or Service)
Employer
Address		City
State		Zip
Employer's Phone
Spouse		Spouse's SSN #
Former Address
Former Employment
Relatives and Friends
Additional Information

Debtor's Name		SSN#
Address		City
State		Zip
Phone		Mail Ret'd
Account #		Amount Owing
Date of Last Charge		Date of Last Activity (Payment or Service)
Employer
Address		City
State		Zip
Employer's Phone
Spouse		Spouse's SSN #
Former Address
Former Employment
Relatives and Friends
Additional Information

Debtor's Name		SSN#
Address		City
State		Zip
Phone		Mail Ret'd
Account #		Amount Owing
Date of Last Charge		Date of Last Activity (Payment or Service)
Employer
Address		City
State		Zip
Employer's Phone
Spouse		Spouse's SSN #
Former Address
Former Employment
Relatives and Friends
Additional Information