Office: 912-261-9133  


Please complete the form as accurately and as completely as possible. Only a certain amount of this information will be displayed on your profile form. Some of your information is used internally in helping our team make recommendations to inquiring creditors and collection agencies on accounts receivable and judgments that they may have for collection, litigation, domestication or enforcement.


Collection Attorney Information

Attorney Name: 
Firm Address: 
Suite or Floor #: 
Province or Country: 
Phone #: 
Email Address: 
Attorney Collection & Law Experience

Years Practicing Collection Law:  

State or Country Bar License #:  

Date Admitted To The Bar:  

 States or Countries Licensed To Practice In:  

Service Area if Not Entire State or Country:  

Collect Consumer Accounts:  

Yes    No

Collect Commercial Accounts:  

Yes    No

Collect or Enforce Judgments:  

Yes    No

Specific Types of Accounts You Do Not Collect:  


% of Your Current Practice in Collection Law:  


Member of Any Industry Associations:  

Industry Recognition Received:  

Attorney Compliance

Compliant With State/Country Collection Laws:   

FDCPA Compliant:  

Yes     No     Not Applicable
FCRA Compliant:   Yes     No     Not Applicable
HIPAA Compliant:   Yes     No     Not Applicable


Schools, Degrees, Dates Attended:  
Name of Law School Attended:  
Law Firm Information
Law Firm Name: 

Year Law Firm Founded: 

  Corporation, Partnership or Sole Proprietor: 

Number of Physical Offices: 

Number of Attorneys In Firm: 

Number of Collectors: 

Total Number of Employees: 

Average Years of Experience Per Collector: 

Prefer Certain Types of Collection: 

Always Use Retainer Agreement: 

Provide Status Reporting: 

Provide Acknowledgment of Claims Placed: 

Provide Accurate & Timely Remittances: 

Website Address: 
Insurance & Bonding

Is Your Firm Bonded:  

Amount of Bond:  

With What Company:  

Bonded Through Law List:  

Which Law Lists Bonded Through:  

Have Errors & Omissions Insurance:  

Amount of Coverage:  

With What Company:  

Have Employee Dishonesty Insurance:  

Amount of Coverage:  

With What Company:  

Your Membership Commitment To NBCA

I declare that the information contained in this membership form is true and correct to the best of my knowledge. I understand that by submitting this membership form that I am entering into a legally binding membership agreement for the term of one year with the National Board of Collection Attorneys (NBCA). I further understand that NBCA will not automatically renew my membership when the current term expires, as the membership is on a year to year basis. 

In addition, I understand that under normal circumstances, I will be offered the opportunity to renew my membership at the discretion of NBCA and that if offered, it is my choice to either renew the membership or cancel it if I prefer to by notifying NBCA. I also understand that by submitting this membership form to NBCA that my annual membership fee is $499.00 as a U.S. Collection Attorney or $399 as an International Collection Attorney, which becomes due and payable upon electronic receipt of the submitted form to NBCA. If you have received a special promotion code, please enter it below for your membership discount and when paying for your membership. I acknowledge that NBCA has the right to terminate my membership at anytime for any reason and that I will receive a pro-rated refund for the time remaining on my membership term.

It is understood that I will be automatically redirected to NBCA's payment portal to make my payment by bank account, credit or debit card or PayPal Credit to NBCA's PayPal account (Debtmonitor). I also acknowledge and understand that it is my duty to supply NBCA (in a timely fashion) with all of the information necessary for them to adequately display and populate my listings across the NBCA Network.

Please DO NOT submit this form unless you have checked the box just above indicating that you agree, understand and acknowledge your membership to NBCA.

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Electronic Signature    





     National Board of Collection Attorneys - 72 Marsh Oak Drive, Brunswick, Georgia 31525 - Office: 912-261-9133 Ext3 Toll Free


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