Request for

Claim Submission Form

Please call us toll free at 877/255 8410 for additional information, OR

COPY THE INFORMATION BETWEEN THE TWO LINES following, then

Company Name:

Contact Person and Title:

e-mail address:
Company website address:

Phone:
Fax:

Street Address :
City: State: Zip:

Please respond to the following questions:

1) How many collection claims do you generally submit

annually:

Monthly:

Occasionally:

2) Please list geographic areas of majority of your clients (e.g. Chicago, San Francisco, Illinois):

CLICK HERE to open an e-mail to PMG, Inc. (If your computer is not set up to open an out-going e-mail, open your e-mail program, and insert the information you copied into your regular e-mail.)

PROVIDE the information requested

SEND the e-mail to: pmg@wildonion.com

Upon receipt we will send you claim forms, our agreement, and suggstions for internal collection procedures you might consider implementing.

We will respond either the same day or the next business day.

Thanks for your interest

Collection services are availabile through
Professional Marketing Group, Inc. (PMG, Inc.)
serving clients throughout the U.S. and Canada.

PMG, Inc.
P.O. Box 165
Mount Prospect, IL 60056

Phone 847/255 8410, or toll free 877/255 8410
e-mail: PMG@WILDONION.COM

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