Collection Agency - CCRC DON ANDREWS ANDREWS TOWERS
729 SINGING TRAILS DRIVE
TOWER SUITE
EL CAJON, CA 92019-2755
TEL: (619) 440-2822
FAX: (619) 749-3098
Alternate mailing address :
P.O. BOX 12676
EL CAJON, CA. 92022-2676


Printable Form

Please send any statement, credit report, NSF checks, invoices, or anything else we may need, to the following email address : collect@ccrc-usa.com , or by fax , or by mail (fax number and address above).

  Debtor  
First Name :   
Last Name :   
Company :   
Address :   
City :   
State/Province :   
Zip :   
Country :   
Telephone :   
Fax :   
Email :   
Amount $ :   
Interest to date  
on past due balance $ : 
 
Total $ :   
Principal of Debtor :   
Debtor's bank :   


Comments : 
 


Enter a brief description and  
the quantity of all the supporting documents you'll send to us : 
 SAMPLE :
 3 Statements
 1 NSF check
 2 Credit reports
 1 Account disputed (details)
 2 Invoices.

  Terms Agreement  

I HEREBY ACKNOWLEDGE AND AGREE THAT THE COMMISSION RATE ON THIS ACCOUNT WILL BE:
   

WE ATTACH HERETO ITEMIZED STATEMENT OF OUR ACCOUNT AGAINST THE ABOVE NAMED, WHICH WE ASK YOU TO TAKE UP IMMEDIATELY AT YOUR RATES, FORGOING YOUR PRELIMINARY SERVICE.

IN THE EVENT THE ACCOUNT SUBMITTED FOR COLLECTION HEREWITH CANNOT BE COLLECTED BY THE DIRECT NEGOTIATIONS OF YOUR STAFF, AND IF WE DO NOT DESIGNATE AN ATTORNEY HEREIN, YOU ARE HEREBY AUTHORIZED AND INSTRUCTED AS OUR AGENT TO FORWARD THE CLAIM TO AN ATTORNEY IN OUR BEHALF. SUCH ATTORNEY SHALL AT ALL TIMES BE SUBJECT TO OUR CONTROL AND DIRECTION, AND NO ATTORNEY SHALL COMMENCE ANY LEGAL PROCEEDING WITHOUT PRIOR AUTHORIZATION.

YOU ARE HEREBY AUTHORIZED TO ENDORSE FOR DEPOSIT AND COLLECTION, IN OUR NAME AND IN OUR BEHALF, ALL REMITTANCES RECEIVED ON THIS ACCOUNT.

     I have read and agree to these terms :   (Required field)
 

  Creditor  
First Name :   
Last Name :   
Company :   
Address :   
City :   
State/Province :   
Zip :   
Country :   
Telephone :   
Fax :   
Email :   
Your Title :   
Your First Name :   
Your last name :