Collection Agency - CCRC DON ANDREWS

Send this form to
collect@ccrc-usa.com
or by fax or mail.
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

 DEBTOR  DATE  AMOUNT $
 ADDRESS  INTEREST TO DATE
 ON PAST DUE BALANCE $
 CITY, STATE/PROVINCE, ZIP, COUNTRY  TOTAL $

PLEASE CHECK ONE 
 DEBTOR'S TELEPHONE NO
 PRINCIPAL OF DEBTORS
 DEBTOR'S FAX NO
 DEBTOR'S BANK
 STATEMENT
 ENCLOSED

 CREDIT REPORT
 ATTACHED

 ACCOUNT DISPUTED
 (DETAILS)

 NSF CHECKS
 ENCLOSED


REMARKS







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.

 CREDITOR  TELEPHONE
 ADDRESS  FAX
 CITY, STATE/PROVINCE, COUNTRY  E-MAIL ADDRESS
 CREDIT EXECUTIVE (SIGNATURE)  TYPE NAME & TITLE