A+ Credit Services, LLC Send completed forms to:
Assignment Form Fax: (715) 381-0285 A+ Credit Services, LLC
Debtor Information P.O. Box 1133
First Name Email: apluscredit@comcast.net Hudson, WI 54016
Last Name
Address If emailing or faxing, just type your full name and the company you
City work for in the signature field instead of actually signing.
State
Zip This document is protected to make data-entry easier. After entering
Birth date information in each field, just hit Return/Enter to go to the next. If you
Social Security # would like any changes to be made, please contact Angie Flanagan.
Day Phone Number 715-386-0093 or apluscredit@comcast.net
Evening Phone Number
Cell Phone Number Social Security Number, Phone Number, Amount and Date fields automatically formatted.
Work Phone Number Just type in the information without any - or () and it will do it for you.
Spouse/Guardian Information
Relationship to Debtor
First Name
Last Name
Address
City
State
Zip
Birth date
Social Security #
Day Phone Number
Evening Phone Number
Cell Phone Number
Work Number
Additional Contact Information
Additional Contact Include service fees, late
Phone Number charges or interest to this
Account Balance Information
Date of last actual service, not late
Total of Services fee or interest.
Date of Last Service
Total Debtor Payment Total Services - Total Debtor Payment -
Date of Last Debtor Payment Total Insurance Payments & Write-
offs.
Total Ins Payments & Write-offs
Current Balance Due
Please let us know of any insurance issues
Additional Information: or if the services were for a minor.
Submission Details
Submitted By Any number/text that helps
Your Business Name you identify the account
Today's Date when paid or for questions.
Account reference number
First Placement with agency?
Calling Phase Only - Contract Fees Apply Are we the first collection
Letter and Calling Phase - See Instructional Acknowledgment agency to attempt to collect
this account via phone?
Nice Pre-Collection Letter
Firm Pre-Collection Letter
I hereby assign this account to A+ Credit Services, LLC per our contract.
Put an "X" before the
option you choose for this
Signature Date account.