Order Form

Company Information:

Company Name: (required)

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Zip: (required)

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What is your Industry (required)
---MedicalDentalEducationEnergyFinanceAutomotiveGovernmentConstructionLegalTechnologyUtilityOther

Primary Contact:

Your Name: (required)

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Kinum's Collection Service Fees:

(You are signing up for Contingency Collections : No payment required)
Kinum's Commission Fees:
40% : If less than 1 year old
40% : If more than 1 year old
50% : Legal
50% : Mail Returns

Questionnaire: (Optional)

What AR Software do you use?
NoneAtnenaHealthPulseQuickBooksRaintreeOther

Interested in our fixed fees Letters Service too?
No25 accounts for $25 each50 accounts for $16.50 each100 accounts for $14.50 each250 accounts for $13.50 each500 accounts for $12.00 each
(If selected, a Kinum associate will approach you regarding the Letters Service in about 1 day. No payment required now. Accounts never expire.)