1. Amount of Claim $

2. Aging of Claim: How many days delinquent: 

3. Check if Fees are added per the credit application/contract, invoices, statements or work order

4. Check if Interest is added per the credit application/contract, invoices, statements or work order

5. Debtor Name:                  

6. D/B/A:                           

7. Address:                         

8. City/State/Zip: 

9. Phone #: 

10. Debtor Contact and Title: 

11. Check box if this is this Consumer Debt? 

12. Commercial debt/Business Type: 

Corporation   LLC or LLP  Sole Proprietor or Partnership              

• Client Documents Provided:

  Credit Application/Contract  Personal Guarantee           Invoices                   
  Statement                    Proof of Delivery            Credit Report                NSF Check Copy             
  Creditor Notes		Work Order		       Judgment if any           

  ---

  Creditor Contact Information

  Name
  Title
  Organization
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Country
  Work Phone
  FAX
  E-mail
  URL

  Client authorizes Integrated Business Services, LLC/IBS Collection Services to endorse for deposit and collection, in client’s name and on client’s behalf, remittances received on the account.  Client will promptly notify Integrated Business Services, LLC/IBS Collection Services, of any payments or other correspondence received.

  Unless there is a supplemental agreement, Integrated Business Services, LLC/IBS Collection Services acceptance establishes your approval of the following rates, terms and conditions:

  TERM AND CONDITIONS

  DIRECT PAYMENTS received after collection has started are subject to standard collection rates regardless of how they are applied by the creditor.

  ACCOUNTS WITHDRAWN are subject to standard rates if payment is received within 90 days of withdrawal.  In addition, if a claim that is deemed collectable by Integrated Business Services, LLC/IBS Collection Services is withdrawn; the full standard collection rate as listed below will be assessed based on the remaining balance; at Integrated Business Services, LLC/IBS Collection Services discretion at the time of withdrawal.

  ATTORNEY FORWARDING will only occur with client consent.  Collection rates change to 40% upon assignment to an attorney and will not exceed 40% (commercial accounts only) without client approval.  Client will be asked to remit specified court costs and/or fees when appropriate.  Attorneys are selected from a recognized law list.  Consumer claims are forwarded at a rate of 45%.

  SETTLEMENTS will only be accepted with client consents.  Settlements are subject to standard collection rates.

  MERCHANDISE RETURNS or FINDERS FEES are subject to one-half of the standard collection rates.

  CONSUMER ACCOUNTS Any obligation of an individual to pay money for goods sold or services rendered primarily for personal, family or household purposes must be identified to prevent client from causing a violation of the Fair Debt Collection Practices Act.  Integrated Business Services, LLC/IBS Collection Services will make this determination if needed.

  CREDIT REPORTING Integrated Business Services, LLC/IBS Collection Services will list on both commercial and consumer credit reports.  Consumer credit information stays on the credit report for seven years.  Should an individual pay the creditor directly it is the creditor’s responsibility to notify Integrated Business Services, LLC/IBS Collection Services, so the credit report can be updated.

  RATES

  Fees are contingent upon collection.  No collection fee is due unless a collection is made, an authorized return is negotiated or prior payment discovered.  Also see “Accounts Withdrawn”.  Rates are subject to change without notice.  Rates vary depending on the type of accounts.

  Commercial Claims-

  Claims 1-90 days delinquent: 16%

  Claims 91-120 days delinquent:18%

  Claims over 120 days delinquent: 20%

  All Consumer debt is at a 35% fee rate.

  All second placements 40%

  Garnishment enforcement or judgments already obtained by council other than our own the fee rate is 45%.