SERVICE REQUEST FORM


Please complete the short form below and a representative will contact you, usually within 24 hours. For even faster service please call us at (229) 246-5533 between 8 a.m. & 5 p.m. EST.

 
  What solutions are you interested in? Let us know.
____ Bad Debt Collection Services
____ Commercial Account Collections
____ Billing Services
____ Pre-Collect Services
   
How would you like us to contact you?
____ Mail
____ E-Mail
____ Fax
____ Merchants Consultant

Please let us know where to send your solutions:
Name: ___________________________________________________
Position: ___________________________________________________
Company: ___________________________________________________
Address: ___________________________________________________
City: ___________________________________________________
State: ___________________________________________________
Zip: ___________________________________________________
Country: ___________________________________________________
Telephone: ___________________________________________________
Fax: ___________________________________________________
Email Address: ___________________________________________________
   

  How would you prefer to place accounts?
____ Paper
____ Fax
____ FTP
____ Email
____ Diskette (Zip disk)
____ Diskette (3.5" Floppy)
   
When do you plan to place accounts?
____ Now
____ Near Future
   
Please let us know if you have any specific questions or concerns below:
 
 

 

 

 

 

 

 

 

 

 

 

 

 
 


To print this form out, click on "File", then "Print".
Please mail the completed form to:

Collection Bureau Associates of Georgia
402 S. West St.
P.O. Box 1823
Bainbridge, GA 39818

 
 

© 2011 Collection Bureau Associates of Georgia, Inc. All rights reserved.

The Collection Bureau Associates marks used herein are service marks or registered trademarks of Collection Bureau Associates, Inc.