This form has been developed to make your job of sending business to CMI easier. Fields with a “(required)” next to them are mandatory, all other fields will only assist our team in collecting your money faster.

Domestic Debtor Information





Invoice Information


Principal or Owner Information

Comments or Story

Debt Information





By entering your company name, your name, and your phone number below, you agree to place this account for collection at the previously agreed upon rates. It is understood that commissions will be charged on all accounts collected, paid direct, withdrawn, or settled by return of merchandise. If you do not currently have an account with Credit Mediators Inc., an account representative will contact you at the number provided to discuss to the creation of your account.