Tell us about you:

Member # and Contact name is all we need unless you want the report ot go to a different address than what is in the member file.

Member #:
Member Contact:
Company:
Phone:
Email:
Street:
City/State/Zip:


Please place for collection:

Company Name:
Address:
City/State/Zip:
Business Phone:
Home Phone:
Fax:
Owner:
Amount to Collect:


Type of Organization:

Proprietorship
Partnership
Corporation
LLC


Brief history of the account including any disputes:

List summary of documents to support the claim
(statements, invoices, NSF check, etc):


Please check type of service desired:

CURE™
Free 10 day demand
Personal Contact
Immediate Collection
Attorney Service

COMMERCIAL COLLECTION SERVICES.
THIS AGREEMENT, between NACM Oklahoma Division, Inc., dba: NACM MidAmerica, and the undersigned subscriber to its Commercial Collection Department, agrees to abide by the Rules & Rates established by NACM.
  1. I agree to notify NACM that payment in full or any part thereof has been received.
  2. I agree that placing an account with NACM authorizes them as my agent to proceed at once to collect the account on the established rule and rates, to accept payments and to endorse, checks, notes, money orders, drafts for deposit, and the net proceeds of which you are to remit to us.
  3. I agree that all accounts are not subject to withdrawal without payment of full commission.
  4. I agree to notify NACM of any settlement proposed or arrangement made with the debtor. (NACM prefers that all arrangements or settlement proposals be forwarded to the collector handling your account).
  5. In the event it becomes necessary to forward the claim to an attorney for leal action, we direct and authorize you as our agent, and as a convenience to us, to send the account to an attorney in the county of the debtor or, where none is designated, to an attorney whose name or firm appears in a law list publication approved by the American Bar Association, upon prevailing rates in the area, net to him/her. Special authorization is required to file suit, compromise or grant an extension.
  6. We agree to provide an itemized statement of the debtors account and will forward to you any correspondence received and/or advise you of any communication from or with the debtor.
  7. We agree to report all payments received immediately to NACM in order to reflect the accurate balance at all times.





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