Client Information
Client Company Name:
Your Contact Name:
Your Contact Phone Number:
Your E-mail Address:
Debtor Information For high volume lists of accounts
please upload spreadsheet
Debtor Company Name: Upload Spreadsheet:
Debtor Company Address: Personal Guarantee?
City: Attach Backup Invoice(s)
State: Attach Backup Credit App.
Zip: Attach Backup Contract
Debtor Contact Name: Attach Other Backup Files
Debtor E-mail Address:
Date of Last Sale:
Amount of Debt: $
Debtor Account Number:
Additional Comments...
Contingency Rate: %
NOTE: After reviewing the debtor information, RMCB will contact you to discuss our fee and other important information before we begin our collection process.