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The Professionals Agency
A National Collection Agency


PO Box 950837
Mission Hills
California 91395

818-891-1344
818-895-0004 Fax

  We want to make it as easy as possible for you to place your account(s). If you only have a few accounts you may want to use the electronic submission form below or simply print a Placement Form from the following links:

Consumer Placement
Commercial Placement

If you have a large number of accounts, please call so we can discuss what options we have available.

  To submit a claim please fill out the form below and click the SUBMIT button. We will begin processing your claim right away, and contact you if we need any additional information.

You will need to fax, mail, or scan and attach to email the:
Collection Contract
The same applies to supporting documents such as copies of contracts and applications.

First Time?   You Will Need To Call And Obtain A Password Prior To Placement

Name   Password  

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CREDITOR INFORMATION

Business Name
Creditor Full Name
Tax ID Number

Address
...City ..
State Zip
..Phone Fax Email

DEBTOR INFORMATION

Last Name
First Name
Middle Name
Jr-Sr

Address...
...City .....
State Zip
Res Phone Work No Ext
Soc Sec No Date Of Birth
ID-Drivers License No Occupation

SPOUSE INFORMATION

Spouse Last Name
First Name
Middle Name
Jr-Sr

Res Phone Work No Ext
Date Of Birth
Soc Sec No

ID-Drivers License No Occupation

GUARANTOR  AND/OR  OTHER RESPONSIBLE PARTY INFORMATION

Last Name
First Name
Middle Name
Jr-Sr

Address..
...City ....
State Zip
Res Phone Work No Ext
Date Of Birth
Soc Sec No

ID-Drivers License No Occupation

ACCOUNTINFORMATION

Account Number
Date Of Default
Balance Due

Account was placed with Attorney/Collector Prior  no yes

Status
Inability To Pay?
Check Returned
Disputed
Mail Returned
Phone No Good
No Response
Other (specify)

Special Instructions - Notes

Account Type

BY SUBMITTING THIS FORM YOU AGREE TO OUR TERMS AND CONDITIONS  Password

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