What's Up Placement Form

CELEBRATION SPECIAL #1
All of us at CCC are very excited to be able to celebrate out 50th year in business! We want to share our success by offering you this special placement form taking an extra 10% off our commission (not rate) when the account is collected. This offer does not apply to any accounts under $500.00.
This form can be used only once for 1,2, or 3 accounts and will expire on March 2, 2012.

Creditor Information:

Company Name (Creditor):

Divisions:

Name:

Street Address:

City:

State:

Zip-Code:

E-Mail:

Phone:

Fax:

Debtor 1 Information:

Name:

Company Name (Debtor):

Account number:

Street Address:

City:

State:

Zip-Code:

Phone:

Amount Due:

Date of Last Charge:

Start immediately
Allow 10 Days

Debtor 2 Information:

Name:

Company Name (Debtor):

Account number:

Street Address:

City:

State:

Zip-Code:

Phone:

Amount Due:

Date of Last Charge:

Start immediately
Allow 10 Days

Debtor 3 Information:

Name:

Company Name (Debtor):

Account number:

Street Address:

City:

State:

Zip-Code:

Phone:

Amount Due:

Date of Last Charge:

Start immediately
Allow 10 Days

Answer to Brain Teaser:

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Mailing Address:

Office Address:

info@commercialcollection.com

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