Welcome to MJR Collections Services

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Please submit the form below to Place Commercial Account with MJR Collection Services.

» Client Information
* - Indicates required fields
*Company Name :
Contact :
*Address :
*City :
*Province :
*Postal Code :
*Telephone :
Fax :
*Email :
» Commercial Placement
Debtor Information
Business Structure :
*Company Name :
Owner :
Company Contact :
*Address :
*City :
*Province :
*Postal Code :
*Telephone :
Fax :
Type of Claim :
Debtor History :	Mail Returned Phone Disconnected Disputed
	Check Returned Inability to Pay Other
Additional Information :

» Guarantor Information
Do you have a personal guarantor ?	Yes No
Guarantor Name :
Guarantor Social Security Number :
Address :
City :
State :
Zip :
Telephone :
Original Amount Due :
Current Amount Due :
Account Number :
Date of Service :
Date of Last Activity :
Do you have a signed contract ?	Yes No
Additional Information :
Please Read Before Submitting
In submitting files for placement, the named client authorizes MJR Collection Services Ltd. to act as it's agent with respect to collections. Furthermore, client authorizes MJR Collection Services Ltd. to deposit all checks received into MJR Collection Services Ltd. Trust account. MJR Collection Services Ltd. will remit funds to client after deducting the agreed contingency fee on or before the 10th day of the preceding month. In addition, client agrees to remit to MJR Collection Services Ltd.. any monies received which were paid directly from the debtor less the agreed contingency fee.

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