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Place an Account

Today's Date: 2/6/2012
Your Company Name:
*Your Name:
Your E-mail Address:
*Your Phone Number:
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Your Past Due Customer's Information

Company Name
Contact Name
Phone Number
Street Address:
Address 2:
City:  State:  Zip: 
Account Number:
Delinquency Date:
Amount Past Due:

By clicking on "I Accept" you acknowledge that you are placing the account for collections with Aidex Recovery Group and have authorized us to begin collection activity. You will receive confirmation of your placement and collection efforts will begin immediately. Also, by submitting this form, you are approving collection activity at the agreed upon contingency rate provided by your sales representative. You also agree to pay this fee on any funds received at Aidex Recovery Group, or paid directly to you, and you will notify us if a direct payment is received after the account has been placed. Because we are accepting this account on a contingency basis, you agree this account is subject to a 15% early withdrawal fee if you wish to close the account within 120 days of placement.


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© 2012 Aidex Recovery Website and
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Privacy Policy
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© 2012 Aidex Recovery Website and
Marketing Design