Assets Management Services, LLC. 

Express Placement

                                              
                                                    AMS, LLC.                           

                                    
                                            (800) 476-6168 PHONE
                                            (775) 514-1885 FAX
                                       
                                              

Client Name
Debtor Company:
Debtor Contact
Date of Last Sale
Past Due Amount
Address Street :
City:
Zip Code: (5 digits)
State:
Contact Phone:
Fax Phone:
Email:
Supporting Documentation::
Comments: