Welcome to Advantage Collection Professionals!


"Our mission at Advantage is simple. We are out to provide the best possible service to our clients at the best possible rates. Our collectors want to collect your money without ruining your company's good name. We want the quality of our services to speak for Advantage and our client base to grow on our good name."

Account Placement Form

Please provide as much information as possible on this form. The more information given, the greater the possibility of recovery. Required fields are marked with an *. Fields that are not required or do not apply may be left blank.

 Your Information  
*Your Name:
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*Company:
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Address:
City:
State:
Zip:
Phone:
Fax:
*Email:
 !Invalid format.
How Did You FInd Us?
 

 Debtor Information  
*First Name:
 ! MI
*Last Name:
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*Address:
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*City:
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*State:
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*Zip:
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Debtor SSN#
Debtor DOB:
Home Phone:
Work Phone:
Cell Phone:
Place of Employment:
Employment Address:
Debtor Bank:
Debtor Bank Acct. No.:
   
Debtor Bank Routing No.:
       
Spouse:
  
Spouse's Empl:
  
Spouse's SSN#:
    
       
Debtor History - Check all that apply:
Can't Pay
Phone Disconnected
Check Returned
No Response
Disputed
Other (specify)
Mail Returned  
       
Additional Information:
*Date of Service:
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*Delinquent Date:
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Date Last Paid:
Patient Name:
Account Number:
Insurance Payment?


Date of Insurance Payment:
Amount of Insurance Payment:
*Balance:
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Interest:
 
 Attach A File or Document  

If you have a document or file pertaining to this case, you may attach it here.

  

Copyright (c) 2007 Advantage Collection Professionals, Inc.  All rights reserved.