MCA Collection Agreement

INDUSTRY TYPE*
BUSINESS NAME
Ex: Metropolitan Collection Agency, LLC
CLIENT NAME*
Ex: John A. Smith
CLIENT TITLE
Ex: President
CLIENT PHONE*
Please enter a valid phone number.
CLIENT FAX
Please enter a valid phone number.
CLIENT EMAIL*
CLIENT ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SETTLEMENT AUTHORITY PERCENTAGE*
Ex: 75% (Recommended)
CLIENT SIGNATURE*

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Date*

MonthDayYear
Date
Should be Empty: