| SERVICE REQUEST FORM | |
Please complete the short form below and a representative will contact you, usually within 24 hours. For even faster service please call us at (229) 246-5533 between 8 a.m. & 5 p.m. EST.
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| What solutions are you interested in? Let us know. | |
| ____ | Bad Debt Collection Services |
| ____ | Commercial Account Collections |
| ____ | Billing Services |
| ____ | Pre-Collect Services |
| How would you like us to contact you? |
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| ____ | |
| ____ | |
| ____ | Fax |
| ____ | Merchants Consultant |
Please let us know where to send your solutions: |
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| Name: | __________________________________ |
| Position: | __________________________________ |
| Company: | __________________________________ |
| Address: | __________________________________ |
| City: | __________________________________ |
| State: | ___________________ |
| Zip: | ____________ |
| Country: | _____ |
| Telephone: | __________________ |
| Fax: | __________________ |
| Email Address: | __________________ |
| How would you prefer to place accounts? | |
| ____ | Paper |
| ____ | Fax |
| ____ | FTP |
| ____ | |
| ____ | Diskette (Zip disk) |
| ____ | Diskette (3.5" Floppy) |
| When do you plan to place accounts? |
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| ____ | Now |
| ____ | Near Future |
| Please let us know if you have any specific questions or concerns below: |
| To print this form out, click on "File", then "Print". Please mail the completed form to: Collection
Bureau Associates |
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