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Call ACSI - Revenue Management Corporation at 800-236-5783 and find out how easy it is to become a client of New England’s fastest growing collection agency.

   
 


Fax Form

  
 

Batch Placement & Web Account Access for Existing Clients

  

Welcome to our online claim submission page. Here you can place your claims with us on line. ACSI - Revenue Management Corporation will also require a signed contract to process your claim.

To mail or fax you information: The Fax Form Page (link on left) may be printed from your browser. The form file may be downloaded for printing on your word processor.

Your Name:
I/WE: , authorize ACSI - Revenue Management Corporation to commence immediate collection on the account listed below. It is my understanding that ACSI - Revenue Management Corporation is a full service collections agent and is to their agreed upon percentage on all accounts placed in collection by this office.


Debtor Information:

Name:
Address:
City:
State/Province:
Zip/Postal Code:
Home Phone:
Work Phone:


Account Information:

Your Account #:
Amount Due:
Last Service Date:
Last Payment Date:

Reported to Credit Bureau? Yes No

Please send copies of all related information (i.e.-itemized bill, NFS Check, original contract) to:

ACSI - Revenue Management Corporation
520 Main Street
Waltham, MA 02452

or fax to (781) 894-4899


Creditor Information:

Company Name:
Collection Exec:
Address:
City:
State/Province:
Zip/Postal Code:
E-mail Address :
Questions or
Comments: