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Placement Form

Commercial Debt Collection
(Immediate Action)

Client Information

New clients, please complete this entire section.
Returning clients, please ensure that your company name is on the first line.

* Indicates a mandatory field.


Please enter your name.
Please enter a valid email address.Please enter a valid email address.


Debtor Information

* Indicates a mandatory field.


Please enter the Debtor's name.
Please enter the Debtor's address.
Please select an item.
Required.Please enter a numeric value. Required.Please enter a numeric value.
A value is required.Please enter a valid email address.


Claim Information

* Indicates a mandatory field.


$ Please enter an amount.Please enter a numeric value. 
% per year.
Client must have documentation showing this rate (credit application, purchase order, contract, invoice, statement of account, etc.).



Please provide a brief explanation in the Comments box below.


Insurance Status

* Indicates a mandatory field.


Please choose Yes or No.

Please choose Yes or No. 


Additional Comments



Submission of this Placement Form to ACA, authorizes ACA (at their expense and discretion) to have its attorneys send a Legal Demand Letter, to the above named debtor on your company’s behalf and with respect to the debt indicated above. E&OE

Pricing for this service

  • Fees charged only on monies collected.
  • Debts under 1 year old – 20% on Canadian funds, 25% on US funds. Debts over 1 year old (any currency) and all debts under $500.00 – 33%
  • Industry specific trade associations and organizations wishing to discuss a strategic partnership are encouraged to contact Client Services at (800) 561-8921 ext. 239.


Terms & Conditions


The Following Terms And Conditions Will Apply To All Services:

  1. All claims submitted to ACA verbally, in writing, or by email are subject to the same terms and conditions. It is the client.s responsibility to read and understand the applicable terms and conditions.
  2. All claims are placed for a minimum fixed period of 180 days. After the initial 180 day period, the client may request cancellation of the claim by providing written notice. The file will be closed 90 days from the date of that notice. All monies collected are subject to ACA.s Regular Commission Rates.
  3. All monies will be held In Trust for a minimum of 30 days, and the client authorizes ACA to endorse cheques (or any other negotiable instruments) for deposit into said Trust Account(s).
  4. Should the client withdraw a file prior to the end of the fixed period described in .2). above, it is agreed that ACA will be compensated for all work performed on said file. If it is later determined that the client received payment within 60 days from the date of closure, those monies are subject to the full commission rate.
  5. Collections include all payments received by ACA or their representatives, the client or their representatives, any credits issued or agreed to by the client and the debtor and any contra transactions between the client and the debtor.
  6. The client shall advise ACA immediately of any collections as described in .5). above, or any other amounts resulting in the reduction of this debt.
  7. Any amounts, with respect to any claim placed with ACA, paid to a party other than ACA, its Legal counsel, the client or in some cases the client.s client, will be subject to Regular Commission Rates.
  8. If, through the efforts of ACA, it is determined that the claim placed with ACA is incorrect due to prior payments, returned merchandise or any credit notes not posted, the amounts in question will be subject to the Regular Commission Rates.
  9. At the discretion of ACA and at ACA.s expense, a Legal Demand Letter may be sent to the debtor on the client.s behalf, by attorneys designated by ACA.
  10. Legal proceedings, other than those mentioned in .9). above will not be commenced unless the client agrees in writing. When legal proceedings are recommended, the client will be advised of the potential fees involved as well as any deposits that may be required.
  11. Claims previously placed with another collection agency (or attorney), will be considered reassigned, and commissionable at a rate of 50% of the amount collected.
  12. Should a debtor become insolvent within the period of ACA.s minimum mandate as described in .2). above, and issue a dividend at a later date, ACA will be entitled to its regular commission rate.
  13. Should a client become insolvent with active collection files at ACA, and those files are removed from our portfolio at the request of the Receiver, Trustee or any other party, ACA will be entitled to charge and be paid reasonable fees for services previously rendered.
  14. The debtor may be charged interest accrued from the due date of the debt in question, and at the allowable interest rate of the province or state in which the debtor receives mail. These monies may be waived, retained by ACA to offset expenses incurred, or remitted to the client, at ACA.s discretion.
  15. Should the client reject a bona fide settlement offer of which ACA recommended acceptance, and then settle (at a later date) for that amount or less, ACA reserves the right to charge the client full commission on the rejected settlement amount.
  16. ACA reserves the right to recover from the client, all (or a portion of) bank charges levied against ACA due to NSF activity stemming from an individual debtor; courier costs and/or investigation charges (including but not limited to skip trace, bank reports, corporation details).
  17. Any changes to these terms and conditions must be completed in writing, and agreed to by all parties.

Completing all steps online resulting in the Submission of an account to ACA, signifies the client’s acceptance of the Terms & Conditions.


I accept the terms and conditions listed above. *
You must agree to the Terms and Conditions by checking the box above.


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