Appointment Of Collection Agent

Appointment of Collection Agent

Agent Name:
Seller Name:
Customer of Seller:
Customer Address:
Interview Date:
City:
State:
Zip:
Customer Phone No.
Email Address:
Account Receivable Balance:$_____

The Agent and Seller agree to the following conditions regarding the Customer account receivable due:

The Agent is appointed, on behalf of the Seller, to collect the account receivable due by the Customer.
The Agent shall receive _____% of the amount collected. It shall be made payable to the Agent once the Seller receives the payment.
The Seller will notify the Customer of the Agent's collection efforts and appointments.
The Seller shall indemnify the Agent from any and all claims and conflicts that arise from the account receivable and the Agent's collection efforts.
The following qualifications shall also apply:

Agent Signature
Date Signed

Seller Signature
Date Signed