Collection Agency | Commercial Placement

Alternative Receivables Solutions, Inc.

Client Information
* - Indicates required fields
*Company Name:
Contact:
Address:
City:
State:
Zip:
Telephone:
Fax:
Email:
Commercial Placement
Debtor Information
Business Structure:
Company Name:
Owner:
Company Contact:
*Address:
*City:
State:
Zip:
Telephone:
Fax:
Type of Claim:
Debtor History :	Mail Returned Phone Disconnected Disputed
	Check Returned Inability to Pay Other
Additional Information:
Guarantor Information
Do you have a personal guarantor?	Yes No
Guarantor Name:
Guarantor Social Security Number:
Guarantor Address:
City:
State:
Zip:
Telephone:
Original Amount Due:
Current Amount Due:
Account Number:
Date of Service:
Date of Last Activity:
Do you have a signed contract?	Yes No
Additional Information?
Please Read Before Submitting
In submitting files for placement, the named client authorizes ARS, Inc. to act as it's agent with respect to collections. Furthermore, client authorizes ARS, Inc. to deposit all checks received into ARS, Inc. Trust account. ARS, Inc. will remit funds to client after deducting the agreed contingency fee. Disbursements will be paid monthly and by the 15th of each month when said monies have cleared our bank. In addition, client agrees to remit to ARS, Inc. any monies received which were paid directly from the debtor less the agreed contingency fee.

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