KC Collect! Collection Application Please review and answer the following questions for risk and insurance purposes. Note: Incomplete applications will not be considered. Question Title * 1. Company name and contact info (address, phone, email). Please also provide your business registration number. Who is the main contact for us to deal with? Question Title * 2. Please provide a brief history of your company (owners, year started). Note: We are unable to represent Real Estate or rental companies. If your business is less than two years old, we require a credit reference. Question Title * 3. Has legal action ever been filed against you (the owner) or a company you have owned? If so, please explain. YES NO If yes, please explain Question Title * 4. Have you or your company ever been in placed collections? YES NO If yes, please explain Question Title * 5. Have you or your company ever filed for bankruptcy? YES NO If yes, please provide details Question Title * 6. Have you ever listed a claim with a collection agency before? If so, who was your previous collection agency? YES NO If yes, please explain Question Title * 7. Are you a member of any local networking groups? (Chamber of Commerce, Trade Associations, Rotary?). YES NO If yes, please list Question Title * 8. Do you currently deal with a law firm? YES NO If yes, please specify Question Title * 9. Who can we thank for your referral? Question Title * 10. I swear that this information is true to my knowledge (type name) Done