Free Web Hosting by Netfirms
 Web Hosting by Netfirms | Free Domain Names by Netfirms

Home Up MFS, L.L.C. About Us Contact Us Feedback Search

Commercial
 

 

Home
Up
Services Offered
Testimonials
In the News
Make a Payment

Please submit basic information below to start the collection process.  A service representative will get back with you for any additional information we may need.

Commercial Collection Placement Form
Client Information
* Indicates required fields
*Company Name:
Contact:  
*Address:
*City:
*State:
Zip:
Telephone:
Fax:
*Email:
 

Debtor Information
Business Structure:
*Company Name:
Owner:
Company Contact:
*Address:
*City:
*State:
Zip:
Telephone:
Fax:
Type of Claim:
Debtor History : Mail Returned Phone Disconnected Disputed
  Check Returned Inability to Pay Other
Additional Information:
 

Guarantor Information
Do you have a personal guarantor ? Yes No
Guarantor Name:
Guarantor Social Security Number:
Address:
City:
State:
Zip:
Telephone:
Original Amount Due:
Current Amount Due:
Account Number:
Date of Service:
Date of Last Activity:
Do you have a signed contract ? Yes No
Additional Information:
 
Please Read Before Submitting
In submitting files for placement, the named client authorizes Mid-South CRI to act as its agent with respect to collections. Furthermore, client authorizes Mid-South CRI to deposit all checks received into Mid-South CRI Trust account. Mid-South CRI will remit funds to client after deducting the agreed contingency fee. Disbursements will be paid monthly when said monies have cleared our bank. In addition, client agrees to remit to Mid-South CRI any monies received which were paid directly from the debtor less the agreed contingency fee.

 

Send mail to info@midsouthcri.com with questions or comments about this web site.
Copyright © 2008 Mid-South Collections, Recovery, & Investigations
Last modified: 05/08/08