866-497-1006

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Collection Claim Placement Instructions

Collection Placement forms received by this office will not be valid or entered into our system without a signed Client Agreement form on file and accompanied documentation showing proof of the claim.

The Agreement and Placement Forms may be submitted by one of three options: 

Complete online (preferred), Mail-in, or by FAX.  Each option is available below.

Feel free to contact us should you have questions or require assistance placing collection claims.

866-497-1006 or 585-385-1046

STEP 1

Sign Client Agreement

Complete and sign the Client Agreement Form.  Returning clients who already have a Client Agreement on file need only to submit Collection Placement forms for each claim being placed unless your information has changed.

OPTIONAL: MAIL OR FAX THE CLIENT AGREEMENT

You may print and sign the Client Agreement and fax it to 585-385-1074, or mail all forms and supporting documentation as soon as possible to:

Your Collection Solution, LLC
P.O. Box 25201
Rochester, NY 14625

STEP 2

Place Collection Claims

Complete a Collection Placement Form for each collection claim you want pursued.  Be sure to attach all supporting documented proof of your claim, i.e. invoice, statement and/or contract.

OPTIONAL: MAIL OR FAX COLLECTION PLACEMENT FORMS

You may complete and print a Collection Placement Form for each collection claim you want pursued. NOTE: The Collection Placement Form is in Microsoft WORD “.doc” format.  Be sure to attach all supporting documented proof of your claim, i.e. invoice, statement and/or contract.  FAX to 585-385-1074, or mail all forms and supporting documentation as soon as possible to:

Your Collection Solution, LLC
P.O. Box 25201
Rochester, NY 14625

IMPORTANT! 

Once a collection claim is placed with Your Collection Solution, LLC it is imperative that you or your staff cease all communications with the debtor. You are required to report to our office any and all payments made to you directly. This requirement avoids unnecessary collection calls to the debtor as stated in the Fair Debt Collection Practices Act. Should you receive communication from the debtor,simply instruct them to contact our office directly. Feel free to contact YCS if you have any questions. 1-866-497-1006

Returning clients who already have a Client Agreement on file need only to print Collection Placement forms for each claim being placed, then fax or mail them to our office.

If you need further assistance in any way, call our agency office and we will be happy to guide you or send you the required forms. 1-866-497-1006

 

Hours of operation:

Monday – Friday 8:00am-4:30pm, Eastern Standard Time

In NY or NJ call toll free 1-866-497-1006
In Rochester NY area dial 585-385-1046
(Fax) 1-585-385-1074

Your Collection Solution, LLC
P.O. Box 25201
Rochester, NY 14625

Electronic Client Agreement Form

  • Date Format: MM slash DD slash YYYY
  • Your Collection Solution, a Limited Liability Company, (YCS), is a Debt Collection Service that abides by The Fair Debt Collection Practices Act. Your Collection SolutionSM, LLC has been hired for the purpose of debt collection, by:

  • The Agreement:

    The nature and extent of services which will be called for and which may be rendered cannot be predicted. YCS will perform collection services on a contingency fee basis. If no money is recovered, no fee for professional service will be due to YCS. YCS will be entitled to receive its fee on all amounts recovered from any source after a claim has been placed with our office. Our fee is 33% of all money recovered. Our fee increases to 40% of all money recovered after referral to an attorney. The 40% fee also applies to judgments you forward to YCS for collection. You agree to cease all communication with the debtor(s) once a claim is placed with our office. If payments(s) are paid directly to you after a claim has been placed with our office, you agree to notify YCS of the amount and date of each payment, and pay the above fee to YCS on the amounts paid directly to you. You also agree to instruct the debtor to make future payments directly to YCS and to communicate directly with YCS. You authorize YCS to deposit and/or endorse checks made payable to you for debts forwarded to YCS for collection.

    YCS will obtain your approval in advance of incurring expenses, and also prior to referring your claim to any attorney for collection. You agree to pay for all approved expenses within 20 days of the date of our bill for the same. YCS provides its own Business Associate Agreement (for HIPAA Compliance) to healthcare providers at no cost. If you choose to use your own Business Associate Agreement, a non-contingent fee of $150.00 will be due to cover legal fees involved in the review of your agreement by our legal counsel.

    When you forward collection claims, please send copies of the following, if available: a YCS Account Placement Form, the bill, invoice, contract, promissory note or other debt instrument, mortgage or other lien proof, the judgment, the credit application, your last demand letter, any other correspondence between you and the debtor about the debt, one of the debtor’s payment checks, and any skip tracing or other relevant notes. Please also let us know the debtor’s (and co-debtor’s) employment, financial accounts, owned real estate and other income and asset information when you have it.

    You agree to provide truthful and accurate information regarding the debt. You acknowledge that YCS will rely exclusively on the information you provide without any obligation to conduct an independent verification. You agree to indemnify and hold YCS harmless from any and all claims and expenses of any nature, including attorney fees and costs of defense, arising out of inaccurate or incomplete information you have provided. You agree to cease all communication with the debtor upon referral of a claim to YCS. By forwarding a claim to YCS, you represent that no other collection agency, attorney or Court Officer is pursuing collection of it, or is entitled to receive a fee based on collection of the claim.

    YCS agrees to handle your claim in a professional and ethical manner.

    You may close a claim if no payment has/had been made by the debtor, subject to the responsibility for fees set forth above and with the following conditions. If YCS is in the midst of negotiating a payment arrangement, settlement or pay-off, the claim cannot be closed until that is concluded. If YCS is obtaining payments from the debtor on a regular basis, the claim may not be closed. If you have authorized placement with an attorney, it may not be closed except with approval from the attorney which shall not be unreasonably withheld, and subject to payment of all Court costs incurred. If a claim is closed by you or YCS, and you have received any direct payment on the claim, YCS will be entitled to receive the above contingency fee on all such payments paid prior to the date of the return or closure. YCS may discontinue the placement and return a claim to you at any time. Upon doing so, YCS will have no further obligation to you and you will have no additional obligation to YCS.

    In the event you fail to pay any amount due YCS under this agreement, you agree to pay the cost of collecting the same, including reasonable attorneys fees. Any dispute arising under this agreement, may be heard and determined in any court of competent jurisdiction in Monroe County, New York. This agreement shall be interpreted under New York law.

  • Authorization

    By signing with your signature electronically below, you represent and warrant that you are a duly authorized representative with full power and authority to enter into this agreement. You acknowledge and agree that you have reviewed and understand this Agreement, and understand you are legally bound by the terms and conditions of this Agreement.

  • Use your mouse pointer, finger, or stylus pen to sign your name. You will be emailed a copy of this agreement upon submission.
  • This field is for validation purposes and should be left unchanged.

Electronic Collection Placement Form

A Signed Agreement Is Required First!

All submitted claims will not be processed until a submitted signed Client Agreement is in place first!