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To List With AgencyCollectors.com Please Complete The Following List Request Form

List Request Form

Firm Description & Web Contact Information

Required Item Email
Company Web Address - http://
Required Item 3 Descriptive Lines about Your company
or product.

(This will be displayed with your listing)

Required Item You must select at least 1 category

Retail Collections
Commercial Collections
Medical Collections

Bad Check Recovery

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Receivables Outsourcing
Related Services

Annually - $295.00 to join via credit card or check

or you can pay

Monthly - $29.00 per month to join via credit card for 12 months


I wish to have my Agency listed in more than one State or Category, I will list all additional states or categories below. 

By default, I understand that my Agency is listed only in the State of my billing address.

Additional States & Categories are: 

Annually - $100.00 per state or category via credit card or check

 or you can pay

Monthly - $10.00 per state or category via credit card

Total to debit credit card  or send check for $__________ or Total Monthly debit to credit card $__________

Please call me as I have numerous states and numerous categories I wish to list In

* All Listing Fees are due upon receipt of invoice. *

Section A.) All AgencyCollectors.com listings are for a 12month duration of time from the date submitted. Your listing will be automatically renewed for an additional 12 month period on the renewal date unless AgencyCollectors.com receives a 30 day notification of cancellation prior to the renewal date. To send a cancellation request, please send to AgencyCollectors.com, P.O. Box 760, Boca Raton, Florida 33429. Should you have any questions regarding this listing agreement, please contact our Florida office at 800-648-1914. 

Required Item Company Name
Required Item Billing Contact
Required Item Address
Required Item City & State
Required Item Zip Code & Country
Required Item Phone ( )
Fax ( )
 Terms of Payment
Please invoice my office and I will pay by check to AgencyCollectors at P.O. Box 760, Boca Raton, Florida upon receipt of invoice.
I would like to pay by: credit card
Card #:
Date of Expiration:
Security Code:
(Last 3 or 4 digits on the back of your credit card)
I understand the terms of this agreement as documented in section A above and hereby authorize my agency listing. 


If you need assistance in completing the listing form, just send e-mail to:


 1-800-648-1914 Toll Free