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Express Placement

Place a B2B account ($1,000 and up) for collection fast using the form below. We'll get started immediately.

New Client
Current Client

Client Company*

Contact Name & Title*

Contact Phone*

Contact Fax*

Street Address*

City, State & Zip*

Email Address*

Debtor Info

Company Name*

Contact Name & Title*

Street Address*

City,State,Zip*

Phone*

E-Mail

Debt Description*

Excuse for Nonpayment

Amount Owed*

Past-Due Since (Date)

Please check here to confirm your acceptance of our terms below. Your Agreement will also be available to print after you click the "Submit" button.

Collection Services Agreement

Miller, Ross & Goldman, herein referred to as "AGENCY" and You,  the party submitting account(s) for collection, herein referred to as "CLIENT" mutually agree that the accounts placed with the AGENCY are subject to the terms and conditions of the following agreement between the parties herein:

1.        All accounts placed from CLIENT will represent valid debts owed to CLIENT by its' customers.

2. 	AGENCY agrees to accept and diligently attempt to effect monetary recovery of all past due receivable accounts, hereinafter referred to as "accounts", submitted and assigned by CLIENT to AGENCY for collection.

3.        AGENCY's Collection activities will be in compliance with all Federal, State, and Local Laws and regulations, and be fair, professional and ethical, consistent with the positive image and good reputation of CLIENT.

4.        All monies collected by AGENCY on CLIENTS' accounts will be deposited immediately into a trust account maintained for CLIENTS' disbursements. All monies collected by AGENCY on CLIENTS' accounts will be remitted to CLIENT less AGENCY'S collection fee, on the 25th of the month following collection of good funds. AGENCY will provide detailed report statements which will illustrate monies collected on CLIENT'S accounts.

5. 	AGENCY assures CLIENT that there are no service charges or up-front fees associated with AGENCY'S collection services.  Fees will be due to AGENCY on accounts CLIENT has submitted to AGENCY for collection upon either party's receipt of payments.  CLIENT authorizes AGENCY to accept and endorse payments, and to deposit in its Trust Account, any and all cash, checks, notes, money orders, drafts for deposit, or other payment instruments, the net proceeds of which AGENCY shall remit to CLIENT as stated in paragraph 4 above.

6.        CLIENT agrees to provide AGENCY with immediate notice on all direct payments, adjustments and disputes received on placed accounts, as well as any and all verbal or written correspondence from any party regarding placed accounts.  CLIENT understands that the applicable fee is due to AGENCY on any and all accounts placed with AGENCY for collection regardless of which party receives payment.

7.        The collection fee on payments made to AGENCY and direct to CLIENT on accounts placed with AGENCY will be based on the following fee table:

Aged 90 to 180 days - 20%

Aged 181 days to 1 year - 25%

Aged over 1 year/Over 2 years - 40%/50%

Individual accounts less than $3,000.00 - 40%

Outside United States - 40%/50%

"Skip" Accounts (No working phone) - 40%

Merchandise Returns - 1/2 of Acct. Rate

Uncollected Judgments - 50%

8.     AGENCY will not initiate legal action without prior written authority from CLIENT. Should legal action be indicated, AGENCY shall consult with CLIENT, and will request a written assignment of the account for such action. All accounts authorized by CLIENT for legal action will be charged at a contingency rate of 35-40%.

9.        CLIENT shall be responsible for all legal fees and court costs on accounts placed with AGENCY for collection and referred for legal action at CLIENT'S request. AGENCY will not be obligated to file suit on any account referred by CLIENT if AGENCY deems such recourse will have unprofitable results for CLIENT and/or for AGENCY. Court costs and filing fees must be paid by CLIENT to AGENCY prior to legal actions being initiated.

10.     CLIENT agrees not to contact or to accept contact from placed customers for the purpose of negotiating payment arrangements.  CLIENT shall refer all placed customers to AGENCY  so that AGENCY may effectively conduct its' collection efforts on CLIENT's behalf.

11.     As further consideration for the receipt and handling and collection of accounts by AGENCY, and for the services rendered to CLIENT by AGENCY, the parties agree that each party will assume its own proper responsibility in connection with any claims made by a third party against CLIENT and/or AGENCY.

12.	In exchange for the monetary benefits relating to the recovery of CLIENT'S accounts, AGENCY agrees that all information relating to the business of CLIENT, including but not limited to the identity of the customers and suppliers of CLIENT, its arrangements with such suppliers, and technical data relating to its products and services, shall be treated as confidential by AGENCY, and its employees, owners, and directors throughout the term of this Agreement and for one (1) year following either party's cancellation of this Agreement

This agreement will be effective as of date shown and continue in effect until terminated as herein provided. Either party may terminate this agreement by giving the other party thirty (30) days notice by email, fax or regular mail.  Termination or cancellation of this agreement by either party will not affect the collection enforcement or validity of any accrued obligations owing between parties.

The provisions of this agreement will override any and all contrary or conflicting provisions contained in the past or present agreements. Their duly authorized and empowered representatives enter into this agreement by and between AGENCY and CLIENT on this ____day of _______ 20___.

VENDOR:

Miller, Ross & Goldman
701 Brazos St., Suite 500
Austin, Texas 78701
Phone 
BY: Michael Ross
TITLE: Chief Executive Officer

_________________________________________
Signature

CLIENT:

Company: _______________________________ 
 
Address:_________________________________ 
 
City, State, Zip:___________________________ 
 
BY:______________________________________

TITLE:___________________________________

_________________________________________
Signature