Accounts Receivable Worksheet Company ______________________________________________________________________ Decision Maker(s) _____________________________________ Phone ___________________ We don't have a one-size-fits-all collection program. We tailor make a collection program to meet your specific needs. In order to do so we need to know a little more about your business. Please take a few minutes to fill out this worksheet so we can generate a proposal with pricing options typically less than 10%. Then at your earliest convenience scan it and return it to the email below, or feel free to fax it to the number below. Keep in mind, any account under 5 years old is collectable money and the more accounts have , the lower the fixed fee . How many locations or offices do you have at this time? __________ How many accounts do you need professional help with at this time (up to 5 years old)? __________ What is the average balance on your delinquent accounts? $___________ How many delinquent accounts would you typically submit to collections on a monthly basis? _____ to _____ Please list your delinquent accounts below in the appropriate categories. All we need is the Name and Amount. Accounts under 2 years old Balances under $250.00 Name Total Amount Accounts 2 to 5 years old Balances over $250.00 Name Total Amount Balances under $250.00 Name Amount Total Balances over $250.00 Name Amount Total Would you like us to collect any accounts your previous agencies have failed to recover? ____ How many? ____ Return to: [email protected] (or) Fax to: 800-577-0293