Pacific Healthcare Services - Nationwide Commercial Debt Collection Agency-Agencies

Step 1. Please fill out the following information and click the button below to continue. "*" denotes a required field.

Tell Us About Yourself:
*Client Name:		*Phone:
*Contact Person:		Add. Phone:
Address:		Cell Phone:
City:		Facsimile:
State:		*Email Address:
Zip Code:

Specify Account Type:	Medical
	Commercial (Money is owed to you by a business or corporation)
	Consumer (An individual owes you the money)
	Check this box if you would you like the Consumer account reported to credit bureaus.

Age of Account: (Date the invoice first due)	0 - 12 Months (30% fee*)
Age of Account: (Date the invoice first due)	13 Months and Older (40% fee*)

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