| Company Name: |
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| Contact Person: |
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| Job Title: |
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| Main Number: |
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| Direct Number: |
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| Email Address: |
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| Fax Number: |
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| City: |
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| State: |
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| Type of Business - Feel free to be descriptive.: |
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Have you ever used the services of a collection agency?:
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In the past, when your internal efforts to collect exhausted, what did you do? Did you hire an attorney, use another collection agency, take the client to small claims court, or write off the account? Please be specific.:
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How many accounts per year do you normally turn over to a collection agency?:
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What is the average size balance of the accounts you normally turn over?:
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PLEASE TELL US ABOUT THE ACCOUNTS YOU WANT TO TURN OVER RIGHT NOW. FEEL FREE TO BE DESCRIPTIVE.:
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Do we have your permission to send you a one time email to follow up with you?:
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Do we have permission to send you a one time fax to follow up with you?:
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Do we have permission to send you a text message on your cell phone, or call you on your cell phone?:
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Cell Phone Number (optional):
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| Tell us what you want to obtain and avoid when doing business with a collection agency?: |
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| Comments: |
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Best Time To Reach You.:
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