Collection Application

Please review and answer the following questions for risk and insurance purposes. Note: Incomplete applications will not be considered.

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* 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?

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* 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.

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* 3. Has legal action ever been filed against you (the owner) or a company you have owned? If so, please explain.

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

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

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* 6. Have you ever listed a claim with a collection agency before?

If so, who was your previous collection agency?

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

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

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* 9. Who can we thank for your referral?

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* 10. I swear that this information is true to my knowledge (type name)

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