*REQUIRED
INFO
Last name
First
name
Your
E-mail:
Company
Name
Address
City
State
Zip
Code
Work
Phone
Extension
Fax
Number
Company
Website
Answering
the following questions is NOT necessary but answering
some or all of the questions will help us better serve
you.
Are
you currently using a collection agency
Yes
No
When
are you looking to switch
Immediately
within the next 30 days
31-45 days
45-60 days
more than 60 days
Not quite sure
Choose
which best describes your industry
Rate
you are currently paying
Frequency
you turn work over to an agency
Whenever we have accounts
Once a month
2-4 times a month
Every 2-4 months
Every 4-6 months
Every 6-8 months
Every 8 months to year or more
Number
of accounts per placement
1
2-5
6-10
10-25
26-50
51-75
76-100
100-250
250+
Average
total dollar amount per placement
$500 - 1,000
$1,000 - 5,000
$5,000 - 10,000
$10,000 - 50,000
$50,000 - 100,000
$100,000 - 500,000
$500,000 - 1,000,000
$1,000,000+
What
is the average age of your accounts when you place with
an agency
Less than 60 days old
61-90 days old
91-120 days old
121-150 days old
151 days old or more
Other
Services needed
Comments
or Questions:
(Please
click one time only!!! )
