CCB Inc Collection Agency

CCB provides excellent collection results at a fair-price to its clients. CCB does its best to collect its clients accounts while treating the patient or customer respectfully.

Most accounts are a “Pay only if we collect” fee. Fixed fee programs are available also.

Please complete the following information and submit. A representative will contact you.

All fields must be filled out except where noted

How many accounts do you place annually?

Less than 50

50 - 200

200 - 1000

More than 1000

What is the average balance of accounts you place for collection?

	Less than $50		$50 - $200		$200 - $500
	$500 - $2000		More than $2000

Which category best describes your business?

	Dental		Medical		Retail
	Utility		Other

What is your name?

Name of your business:

What services are you interested in?

Please indicate how you would like to be contacted (fill in all that apply):

Telephone:

Fax:

Email: