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Placement Form

Business Hours: 8:30 AM - 5:00 PM Monday - Friday ( CST )

Request Information

For additional information regarding our services, please send us an E-mail or fill out the form below with your request or comments. A service representative will get back with you in a timely manner.

By clicking the above button you agree to the following: This form authorizes United Mediation Services, Inc. to begin immediate collection action and all payments remitted directly to you after the date entered above shall be deemed as having been collected by us, and shall incur the full applicable collection fee. If no collection is made, there will be absolutely no charge for our services. We also agrees to pay client for any monies sent to us by the debtor within 21 days of receipt of payment. All collection activities will be undertaken in accordance with all state and federal collection laws.

Confirmation will be Faxed, Mailed or E-Mailed within 24 Hours

*This website is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is legally privileged. Information submitted on this site is considered confidential and will not be shared or sold to third parties.