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D R I Services PLACEMENT FORM
Please fill the account placement form out with the correct information. Accounts placed from the online form are property of Direct Recovery Investigations All accounts are set up after submitted and worked immediately. There is no turning back. By clicking submit you are automatically agreeing to the terms of our No Collection No Charge agreement. If you have any questions contact: csd@driservice.com
Date
*
Client Co Name
*
Client Phone#
*
Client Fax
Client Cel
Client First and Last Name
*
Client Email
Client Address (New Client Only)
Client Number
Balance
*
Account Rep
PRIME/NON-PRIME
*
PRIME
NON-PRIME
Debtor Name
*
Debtor Co. Name
*
Debtor Co. Address
*
Debtor Co. City
*
Debtor Co. State
*
Debtor Co. Zip
*
Debtor Co. Phone
*
Debtor Co. Fax
Debtor Co. Cel
Debtor Co. Email
DOCUMENTATION
SSN
Proof of Dlivery
Personal Guarantee
Bank Info
NSF Check
Credit Application
Invoices
Rate
*
Please select
50%
40%
35%
33.33%
30%
25%
20%
15%
Amount Owed
*
Last Date of Sale or Payment
*
Notes
All information provided is to be said true and not falsified, made up or fabricated in anyway. Making up debtor information will result in immediate termination of the account and fees will apply.
Thank you,
DRI Management.
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