Advanced Collection Services Ltd.

Commercial Account Application Form

Any account listed not under arrangement of payment or contact may be withdrawn on written request after 90 days.

ACCOUNTS SERVICED DAY RECEIVED

Additional Information
Company Information
Legal Name
Trade Name
Business Address
City		Postal Code
Mailing Address
City		Postal Code
Business Phone	Phone 2		Fax
Company Is
Principal
Name		Title
Bank		Branch
City		Contact
Phone		Fax
Account Details
Amount To Be Collected	Principal		Plus Interest
Date of last payment or invoice		Amount of last payment
Interest rate charged on overdue accounts	Interest effective date		Account number or client reference number
Credit Application	Yes No	Personal Guarantee		Yes No
Existing Judgement	Yes No	Previously Listed		Yes No

Creditor Information

Client Number
If you already have a client number your company name, contact person and telephone number will be sufficient.

Name

Contact Person

Address

City

Province or State

Postal or Zip code

Country

Phone Number

Fax

E-mail

Creditor Information		Client Number If you already have a client number your company name, contact person and telephone number will be sufficient.
Name
Contact Person
Address
City
Province or State		Postal or Zip code
Country		Phone Number
Fax		E-mail

Advanced Collection Services Ltd.

Commercial Account Application Form

Company Information

Principal

Account Details

Creditor Information

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