ASSET COLLECTIONS INC
Client Name______________________________________________
Sales Representative ____Ray Hannaman_______________________
Authorized by ____________________________________________
FOR IMMEDIATE COLLECTION ACTIVATION
Fax to Asset Collections Inc
Fax Number (503) 488-5823
Debtor Co. Name ______________________________________ Rate ____________%
Telephone _____________________________ Fax _____________________________
Address_________________________________________________________________
City ___________________________________ State ___________ Zip _____________
Principle Amount $_____________ + Add-on $___________ = Total $______________
Date of Last Invoice ________________ Date of Last Payment ____________________
Comments ___________________________________________________________________________
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