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 or your company? If so, please explain.

Question Title

* 4. Have you or your company ever been in placed collections?

Question Title

* 5. Have you or your company ever filed for bankruptcy?

Question Title

* 6. Have you ever listed a claim with a collection agency before? If so, who was your previous collection agency?

Question Title

* 7. Are you a member of any local networking groups? (Chamber of Commerce, Trade Associations, Rotary?).

Question Title

* 8. Do you currently deal with a law firm?

Question Title

* 9. Are you familiar with Microsoft Excel?

Question Title

* 10. Who can we thank for your referral?

T