DOCUMENTATION

Collector Forms

Client or Company Name (Your information):
Contact Name:
Address:
Agreed Contingency Fee:
Telephone:	Fax:
Email:
Customer Name (Account to be collected upon):
Customer Account #:
Address:
City:	State: Zip:
SSN:
Home Telephone:
Employer:	Employer Telephone:
Co-Signer Customer Name:
Address:
City:	State: Zip:
SSN:
Home Telephone:
Empoyer:	Employer Telephone:
Financial Information
Principal Balance:	Accrued Interest: Int. Rate:
Late Charges:	Total Balance Due:

Additional Information:

If you need to fax or e-mail supporting documentation please contact:

Jack Cecil
Phone# 888-244-7859
Fax#: 214-320-3812
Email: pickcrs@airmail.net