(Fields Listed in Red are Required Fields)
Debtor Name
Acct. #
D/B/A
Street Address
City
State		Zip
Phone		Fax
Contact, Title
Principal Amount
	Immediate Placement     10-Day Free Demand
Interest rate to be added -indicate per month or per year	%
	Add fees, per your customer agreement/credit application
	Commercial placement           Consumer placement
E Mail
Client Experience	# Days Delinquent     Mail Returned     Broken Promises
	Ignores Demands     NSF Check(s)      Unable to Contact
	Dispute (Include Summary)
Documentation to be Faxed/Sent	Contract     Invoice(s)     Personal Guarantee
	Credit Application      Judgment       Promissory Note
	Credit Report       NSF Checks       Statement
	Bank/Other
	Client authorizes NACM Gateway 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 NACM Gateway Collection Services of payments or other correspondence received.
Client
Member #
Address
City	State     Zip
Phone #	Fax #
Signature on File	Yes     No (Please Submit Signature)
Credit Representative
Representative Title
Notes
		2275 Cassens Dr., Suite 107 Fenton, MO 63026 636-680-9211 or 1-888-744-9329 Fax 636-680-9219 or 1-888-744-9340

 

Unless there is a supplemental agreement, NACM Gateway Collection Services acceptance establishes your approval of the following rates, terms and conditions.

TERMS 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ACCOUNTS WITHDRAWN are subject to standard rates if payment is received within 60 days of withdrawal. If a claim that is deemed collectable by NACM is withdrawn; there will be a 10% administrative fee assessed at NACM Collection Services' discretion at the time of withdrawal.

ATTORNEY FORWARDING will only occur with client consent. Member collection fees are 45% upon assignment to an attorney and 50% for non-member companies. Fees for international claims requiring legal action will be negotiated as needed. Client will be asked to remit specified court costs and/or fees when appropriate. Attorneys are selected from a recognized law list.

SETTLEMENTS will only be accepted with client consent. 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 or services purchased primarily for personal, family or household purposes must be identified. Consumer accounts must be properly identified to prevent client from causing a violation of the Fair Debt Collection Practices Act. If the client is unsure if an account is a consumer or not, please call.

CREDIT REPORTING NACM Gateway Collection Services does list on consumer credit reports. This information stays on the credit report for seven years. Should the individual pay the creditor direct it is the creditor's responsibility to notify NACM Gateway Collection Services so that the credit report can be updated. The standard collection rate will then apply.

RATES

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

International Claims  -  30%
     International claims requiring legal action will be negotiated as needed.

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