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Placement Form
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Placement Form
Account Placement Form
Debtor Information:
Client ID
Amount
Fees $
Company Name
(required)
Total $
(required)
Address
Phone
City
State
(required)
Zip
Cell
Contact Name
Email
Backup Information Provided or Available
Invoices
Credit Report
Personal Guarantee
Credit application
Statements
Collection Notes
Original Checks
Additional Backup
Remarks
Reason Debtor is Not Paying
Client Information:
Client’s Company Name
(required)
Client Acct.
Address
(required)
City
(required)
State
(required)
Zip
(required)
Phone
(required)
Fax
Email
(required)
Assigned By
(required)
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