Place an Account

Forwarded by (New Customer Information)

Name

Last Name

Title

Organization

Address

Country

Work Phone

Home Phone

Fax

URL

Placement Details

Name

Last Name

Address

Country

URL

Phone 1

Phone 2

Toll Free

Fax

Time Zone

Primary Contact Info

Title

Name

Last Name

Phone

Extension

Fax

Outstanding Details

Customer Ref #:

Last Sale Date

Principle Amount:

Other

Client Added Fees

Interest

Total Due

Facts

Where does debtor Bank?

What product/merchandise was sold?

Last Call:

Account Executive:

Contact:

Operating Unit:

Attachment(s)

File Upload

** NOTE: Files over 16MB may not attach to the form submission. Please e-mail any relevant documents to info@ggrinc.com if needed. Thank you! **

File Upload

** NOTE: Files over 16MB may not attach to the form submission. Please e-mail any relevant documents to info@ggrinc.com if needed. Thank you! **

File Upload

** NOTE: Files over 16MB may not attach to the form submission. Please e-mail any relevant documents to info@ggrinc.com if needed. Thank you! **

File Upload

** NOTE: Files over 16MB may not attach to the form submission. Please e-mail any relevant documents to info@ggrinc.com if needed. Thank you! **