Central Mercantile
Credit Services

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Premium Collection Services
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

We request collection of this account which is not a consumer debt as defined by the Fair Debt Collection Practices Act, and we attach the enclosed statement and supporting documents. You are to begin with the following designated service: CLAIMS NOT DESIGNATED WILL BE MADE UP IN PERSONAL SERVICE.

FREE DEMAND
PERSONAL SERVICE
SMALL CLAIMS RATE
50% of accounts of $200.00 or less
$100.00 Minimum fee on accounts of $200.00 to $400.00

COMMERCIAL CLAIMS
Amounts collected on a per claim basis
between $400.00 and $3,000.00 - 25%
over $3,000.00 - 18%

Return merchandise or equipment - 50% of prevailing fee.

FACE TO FACE COLLECTION SERVICE
The charge for this service is a $495.00 non contingent fee and a flat contingency of 12 1/2% of the sums collected.
INTERNATIONAL CLAIMS - 35%
Claims against debtors outside the United States. Where Attorney services are needed rates may vary from Country to Country.
THIS ACCOUNT HAS BEEN DISPUTED BY CUSTOMER
Indicate below the nature of the dispute.
IT IS IMPORTANT THAT ANY DISPUTE BE REPORTED.

It is agreed that all payments reported to you within the 10 day FREE DEMAND period are not subject to a collection charge. Amounts are not accepted for FREE DEMAND only. Accounts are not subjected to withdrawal for reason of promise of payment, settlement, etc. without commissions being paid at the standard rates. If said claims are not fully paid they will automatically proceed to Personal Service, and if necessary to Forwarding Service. Commissions are charged at the applicable rate for the Service in effect as of the date payment notification is received by CENTRAL MERCANTILE CREDIT SERVICE.

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

SEND ADDITIONAL PLACEMENT FORMS

    OR   

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Visit our offices in Detroit or Minneapolis.

Central Mercantile Credit Services
66 Boone Hills Drive, St. Peters, MO 63376
Phone: (636) 926-3709 Fax: (636) 926-3452
Toll free: (800) 322-1724
cmcsmo@cmcs.com


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