MANAGEMENT KONCEPTS, INC.

COLLECTION AGENCY AND MEDICAL BILLING SERVICES

CLIENT ONLINE REPORTING FORM

Client Name: Date (YY/MM/DD):

Client E-Mail: Your name:

DEBTOR INFO:

Debtor Acct #:		Debtor Last Name:
First Name:		M.I.:

PAYMENT INFO:

Payment date:

Amount Paid:

ADJUSTMENT INFO:

Adjustment Reason:
Adjustment date:		Amount Adj:

STOP WORK ON ACCOUNT:

Stop date:

Stop Reason:

NEW DEBTOR ADDRESS:

Address:		City:
State:		Zip:
Debtor home phone:		Work Phone:

COMMENTS:

Press  and your request will be sent

or press to start again.

Once the form is submitted it will show a "Thank You" page-then you can hit the back button or click "home"

Home | FAQ's | Computer System | Brochure | Rates | Contract | Photos | Placing Accounts | Forms | Online Placements | Online Reporting | Debtor Inquiry | Child Support | Web Design | Medical Billings | EMAIL US | E-Z Collect Letters | San Antonio Child Support Info Center | Links | Filepro Plus

© 1999-2004 Management Koncepts, Inc.
SITE BY: MKI Web Design.
www.geocities.com/mkiwebdesign