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Commercial Account Form

Owner's Name
Surname First
Business Name
Residence Address
Tel. #
Business Address
Mail Returned Yes
Tel. #
Your Account
Ref. #
Type of Goods Sold
or Services Rendered
If Partnership - List Partners
If Corporation - List Officers
Signed Note
or Contract
Principal Only $
Date of Last
CLI. Interest $
FIN. Charge $
Date Interest
Figured to
% Rate %

Commercial accounts are defined as claims vs. a Corporation, a Partnership, an individual doing business, or any other business entity actively engaged in business at the time of and throughout the assignment for collection. In the event the business named above becomes defunct, I understand and hereby authorize the account(s) to be placed in the retail division of the Western Capital International , Inc. at the rate of 50% - contingent upon collection.

The above claims are justly due and are hereby assigned to you with authority to collect, sue, discharge and to endorse checks or money orders sent to you in our behalf. You will advance court costs or collect them from those listed above. You will send us 100% of principal collected minus any commissions due you. The rate is contingent upon collection -- no collection, no charge. You retain any surplus over face value of the account.

A discovery fee of 1/2 the commission rate will apply for locating payments and for effecting merchandise or equipment returns for settlement of accounts. Western Capital International , Inc. will not be obligated to file suit on any claim and is not liable for claims becoming barred by the Statute of Limitations. A faxed or E-mail signature will be accepted to be the same as the original signature by both parties.

We and Western Capital International ., Inc. by virtue of us assigning and them accepting our accounts for collection, agree to hold each other harmless from any and all damages, attorneys fees and costs for any errors, negligence or wrongful acts committed by either involving an account assigned to them by us. WE AUTHORIZE YOU TO ENDORSE CHECKS AND MONEY ORDERS.

Name of Firm
Your Business Address
Cont. Lic. #
Bus. Lic. #
Signed by


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