Collection Agency Information

Submit Checks For Collection

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Before ProCheck can collect on any returned checks, we need to collect a little information about your agency.

Please fill in all of the following information. *

* Notice: You will be held responsible for any false information submitted. See legal disclaimer for more information.

	Company Info:
	Company Name:
	Address:

	City, State & Zip:
	Phone:
	Fax:
	E-Mail:
	Contact Name:

	Please list the merchants you will be collecting for:

	ACA Member Number:
		Don't have an ACA Member Number? Go to ACA On-Line for more information.