COLLECTIONS QUOTE REQUEST FORM

1. FILL OUT THE FORM BELOW.
2. SIT BACK AND LET US DO THE REST.
3. DEPOSIT YOUR CHECK IN 5 DAYS.

DON'T BELIEVE US?
GIVE US YOUR BIGGEST, HARDEST ACCOUNT
     AND WE'LL GET YOUR MONEY!
CONTACT NAME* TYPE OF DEBT*
COMPANY* HOW MUCH ARE YOU OWED?*
PHONE* NUMBER OF ACCOUNTS*
E-MAIL* AVG. AGE FROM LAST PAYMENT*
BEST TIME TO CALL NOTES / COMMENTS

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