Fill out and return to receive an 8.5% rate on your next placement!

*Only good for one in-house, domestic placement per client and valid through 12/31/15. Regular forwarding and legal rates apply.















    We assign the above account exclusively to you for collection. As our agent, you are authorized to proceed at once to collect the account. In the event it becomes necessary to forward the claim to attorneys, we direct and authorize you, as our agent and as a convenience to us, to send the account to an attorney designated by you or where none is so designated to an attorney whose name or firm appears in a law list publication, upon prevailing rates in the area, net to him/her. You or our attorneys are authorized to accept payments and to endorse checks, notes, money orders or drafts for extension. We further understand that if we authorize legal action, a suit fee or charge for legal services provided by the attorney will be made in addition to the regular collection fees. We also understand that upon withdrawal of this account, any payments, settlements, or return of merchandise received by us after the assigned date will be subject to regular fees.