Business Leads Application

Please submit the application below if your collection firm desires to receive fresh, high quality collection client leads.  No payment will be required or requested until your collection firm has been approved to receive leads.  Please answer all questions accurately.

Your Name:  

Company Name:  

  Email Address:  

Street Address: 

City, State & Zip:  

Business Phone:  

Fax:

Official Date Company Started In Business:  

Can you provide 3-5 testimonials?:   

 Yes  No 

Clean history of legal compliance?:  

 Yes  No 

Ever sued by a client/customer?:  

 Yes  No 

Ever filed bankruptcy?:  

 Yes  No 

Competitive pricing in your market?:  

 Yes  No 

Who do you primarily sell to?:  

Consumer  B2B  Both 

Please indicate your monthly budget for leads:  

Note: This  system will yield more production than most sales agents. Keep this in mind when calculating your monthly leads budget.

Briefly describe the goods and/or services you provide:  

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