Credit Control, LLC.

New Client Entry Form
NOTE:  Shaded Fields Are Required
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Who Is Requesting
Basic Information
Client Contacts
Financial
Pay Arrangements
Credit Bureau
Who Is Requesting
 Person Requesting:
 This is the person who is requesting the client be set-up.
 
 Person Requesting's Email Address:
 This is the email address of the person who is requesting the client be set-up.
 
 
Basic Information [ Top ]
 Client Number:
 If you do not know the new Client Number, please leave this blank.
 
 Copy From Client Number:
 If the new client is similar to an existing client, list the existing client number here.
 
 In Set With Client Number:
 If this client record is part of a larger entity or group, list the master client record here.
 
 Office:
 
 Client Name:
 Please type the name as you would like it to appear on debtor letters and client statements.
 
 Address 1:
 
Address 2:
 
 City:
 
State:
 
 Zip:
 
 Main Phone Number:
Please enter like such: (###)-###-####
 
Main Fax Number:
Please enter like such: (###)-###-####
 
Web Site Address:
Please enter the full URL for your website (e.g. http://yourwebsite.com)
 
Tax Id:
 
 Client Class:
 
 Sales Person:
 
Allow Legal: Yes
No
 
 Client Contacts [ Top ]
 Contact 1 Full Name:
 Please enter the full name here (please format First Middle Last).
 
 Contact 1 Phone Number:
 Please enter the telephone number, and extension. Please format (###)-###-#### / ext.
 
 Contact 1 Fax Number:
 
 Contact 1 Email Address:
 
 Contact 1 Title:
 
 Contact 1 Role:
 
 
 Contact 2 Full Name:
 Please enter the full name here (please format First Middle Last).
 
 Contact 2 Phone Number:
 Please enter the telephone number, and extension. Please format (###)-###-#### / ext.
 
 Contact 2 Fax Number:
 
 Contact 2 Email Address:
 
 Contact 2 Title:
 
 Contact 2 Role:
 
 
 Contact 3 Full Name:
 Please enter the full name here (please format First Middle Last).
 
 Contact 3 Phone Number:
 Please enter the telephone number, and extension. Please format (###)-###-#### / ext.
 
 Contact 3 Fax Number:
 
 Contact 3 Email Address:
 
 Contact 3 Title:
 
 Contact 3 Role:
 
 Financial [ Top ]
 Regular Fee %:
 
 Legal Fee %:
 
 Net Gross:
 
 Free Demand Days:
 
 Phone Check Fee:
 
 Remittance Schedule:
 If 'other' is chosen, please explain in the comments section at the top of the page.
 
 Pay Arrangements [ Top ]
 Minimum % with out Authorization:
 The minimum percent of the total balance that a collector can accept as settlement in full with out checking with the
 client.
 
 Minimum % with Authorization:
 The minimum percent of the total balance that client will allow to settle the account, provided we receive approval.
 
 Credit Bureau [ Top ]
 Report to the Credit Bureau: Yes
No
 
 Number of Days:
 Number of days after the account has been listed, to report the account to the credit bureau.
 
 Minimum Dollar Amount:
 Minimum dollar amount of an account sent to the bureau; defaults to $50.00.