Please fill out this form and someone from AccelCheck will contact you.
Full Name: 
Company Name: 
DBA Name 
(If different): 
Ownership: 
Corporation
Partnership
Sole Proprietor
Type of Business : 
Address: 
Address2: 
City: 
State/Province: 
ZIP/Postal Code: 
Country: 
Multiple Locations: 
No Yes  
Contact Telephone: 
Contact Fax : 
Email: 
Number of 
Returned Checks: 
Average Check:  $
I Have Old Checks 
I need Collected: 
No Yes Number Of Old Checks: 
How Did You Find Us:  
Approximately how 
many bounced checks 
does your business 
receive per month?: 
10 10-50
50-100 100-500
>500
How do you currently 
handle bad checks ?: 
Comments: