Collections Plus, Inc. Collection Agency, Grand Rapids Michigan

Contact CPI
Email CPI
Ph (616) 281-9404
Fax (616) 281-9406
2150 44th St.
Suite 102
Grand Rapids MI 49508

The more information you supply, the quicker we can get you your money!
Fields with a '*' are required.

Debtor Information

Debtor*:
Address*:
City*:
State*:	Zip*:

Date*:
Amount*:
Acct No.:

Debtor Contact:

Phone:

Debtor Bank:

Acct. No.:

Additional Debtor Contact:		Bus. Phone:
		Res. Phone:

The following boxes represent the information you have to validate the above debt. Please check all that apply and then fax the documents to (616) 281-9406 or
email the documents to CPI.*

Statement	Credit Report	Guarantee
Invoices	Bad Checks	Correspondence

Business Type:

Corporation

Partnership

Proprietorship


Experience:	Broken Promises	Partial Payments Stopped
	Bad Checks	Dispute
Date of Last Payment:
Remarks/Special Instructions:

Select Service Type

Please Check One of the Following*:

Free Pre-Collect Service

Proceed with immediate collection of the above account subject to your rate schedule.

Proceed with collection upon the expiration of a day Free Demand Period. This period is not to exceed 14 Calendar Days and will commence on the date of our acknowledgement letter to you.
Note: IF NO FREE DEMAND IS INDICATED WE WILL BEGIN IMMEDIATE COLLECTION

FAX OR E-MAIL STATEMENT OR INVOICE IN DUPLICATE

We assign the above account to Collections Plus, Inc. for collection and fully authorize you to collect the account subject to your rate schedule. We shall report promptly all payments and communications received from the debtor.

I agree to the above terms*

Creditor Information

Creditor*:
Address*:
City*:
State*:		Zip*:
Contact*:
Phone*:

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