Premium Collection
Services, Inc.

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Single Placement Form

Items in red are required
Date:
Debtor Name:
Account Number:
Address:
City:
State:
Zip Code:
Phone:
Amount:

Supporting documents to
follow by fax or mail:

Statement, Invoices
Copy of security
Credit Report or
Financial Security
Copy of note
Copy of Personal Guarantee
Other
Name of Principle:
Comments
Consumer Rates:
33 1/3% on all collected accounts over $200.00

50% on accounts over $200.00 and under.

Legal Services: If an account is placed with attorneys for recovery, the contingent fees are 40% on monies collected where suit has not yet been filed and 50% on monies collected after suit has been filed. The client would be responsible for making advancents of court cost where suit is approved.


THIS ACCOUNT HAS BEEN DISPUTED BY CUSTOMER
Indicate below the nature of the dispute.
IT IS IMPORTANT THAT ANY DISPUTE BE REPORTED.

CREDITOR:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:
By:

SEND ADDITIONAL PLACEMENT FORMS

    OR   

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Premium Collection Services, Inc.
822 East Grand River, Brighton, MI 48371
Phone: (810) 229-4833 Fax: (810) 229-9313
Toll free: (800) 322-1724
info@premiumcollectionservices.com


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