Place Account "*" indicates required fields FacebookThis field is for validation purposes and should be left unchanged.Client Information (Creditor)Company Name*Phone Number*Contact Name*Email Address* Physical Address Street Address Apt/Suite No. City State / Province / Region ZIP / Postal Code Debtor InformationDebtor Company Name*Phone Number*Contact Name*Fax numberEmail Address Physical Address Street Address Apt/Suite No. City State / Province / Region ZIP / Postal Code Date of Most Recent PaymentMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Balance Owed*CommentsPersonal Gaurantee (PG)Yes, attach a copyNoStill in Business?YesNoInvoicesAccepted file types: pdf, doc, docx, ppt, pptx, xls, xlsx, jpg, png, Max. file size: 12 MB. StatementAccepted file types: pdf, doc, docx, ppt, pptx, xls, xlsx, jpg, png, Max. file size: 12 MB. Credit ApplicationAccepted file types: pdf, doc, docx, ppt, pptx, xls, xlsx, jpg, png, Max. file size: 12 MB. Additional Back-UpAccepted file types: pdf, doc, docx, ppt, pptx, xls, xlsx, jpg, png, Max. file size: 12 MB. Consent*By submitting an account for collections using this form you hereby authorize RAB, Inc. to begin IMMEDIATE collection activities. Please report all payments promptly. Should the debtor attempt to contact you directly you hereby agree NOT to communicate with the debtor and will refer them back to RAB, Inc. Cancelling/Withdrawing an account submitted for collections will result in full commission to be due. I agree to these conditions.Thank You For Your Continued Trust
