PLEASE PRINT THIS FORM AND, AFTER FILLING IT OUT WITH AS MUCH INFORMATION AS POSSIBLE, FAX IT TO (718) 275-5286

DATE_____________

Please accept this account for immediate collection:


________________________________     ________________________
Company or Trade Style of Debtor     Individual to contact at Debtor's                                      Business
_________________________________________________________________________
Address                                 City         State     Zip

( ) Corporation   ( ) Partnership   ( ) Individual   $_______________
                                                      Balance Due
__________________________                _____________________________
Bank                                      Date of First & Last Invoice
                                          _____________________________
                                          Debtor's Telephone #
Enclosures                                ______________________________
( ) Contract                              Debtor's Account #
( ) Note                                  ______________________________
( ) Returned Check                        If Placed By Phone Our File #
( ) Other Papers
( ) Itemized Statement
( ) Itemized Invoices

Recommended Commercial Rates

25% on the first $5,000.00            Minimum Commisson of $100.00 if
20% on the excess of $5,000.00        collection is between $200.00
Non-Commercial Claims. . . 50%        and $400.00. 50% if total is
Outside U.S. Mainland. . . 40%        under $200.00.
We charge 1/2 of our usual fee on returned merchandise.

Where necessary, you are authorized to forward this account to a bonded attorney of your choosing in debtors jurisdiction.
Assigned By: ____________________________________________________________
                                       Creditor
             ________________________                   _________________
             By (Your Name)     Title                   Telephone Number
                                                        __________________
                                                        Fax Number
             _____________________________________________________________
             Street                             City       State    Zip