Central Mercantile
Credit Services

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International
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.

INTERNATIONAL CLAIMS - 35%
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.

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:

    OR   

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Visit our offices in Detroit, Minneapolis
or our International Office.

Central Mercantile Credit Services
822 E. Grand River, Brighton, MI 48116-1895
Phone: (810) 229-9385 Fax: (810) 229-5540
Toll free: (800) 223-6259
cmcsmi@cmcs.com


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