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Fill out the form below for your case to be reviewed by RPS.

Your Name:

Your Company:

Address1:

Address2:

City:

State:

Zipcode:

Phone:

Email:

Approximately how many
INDIVIDUAL (Consumer)
accounts are you looking
to collect?

0 - I only have Commercial (Business) accounts to place
5-25
25-50
50-100
100+

Approximately how many
COMMERCIAL (Business)
accounts are you looking
to collect?

0 - I only have INDIVIDUAL (Consumer) accounts to place
1-5
6-25
26+

Approximately how long
have the accounts been
outstanding?

0-180 Days
180 Days - 1 Year
1 Year +

Please tell us about
your business and
your efforts to collect
these accounts.

How did you hear about us?

Referral
Google
Yahoo!
MSN / Live Search
Other

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