Professional Placement Services

Name

PPS Account Number

Email

Phone Number

Subject

Message

This communication is from a debt collector. This is an attempt to collect a debt. Any information obtained will be used for that purpose. By completing and submitting this form, I understand the following: I am authorizing Professional Placement Services. (“PPS”) to send me any and all communications electronically (“Electronic Communications”). Electronic Communications includes e-mail, current and future notices and/or disclosures that may be required by law, correspondence, statements and other communications regarding any account placed (now or in the future) with PPS. I am acknowledging receipt of this Electronic Communication Consent form, my intent to be bound by the terms of this form and that I am signing this form electronically. I am acknowledging that Electronic Communications: can be intercepted, altered, forwarded or used without authorization or detection, can be circulated, forwarded and stored in paper and electronic files, and may be lost due to technical failure during composition, transmission or storage. I am not providing PPS with an e-mail address provided to me by my employer or related in any manner to my workplace or place of employment. I am acknowledging that I do not have a reasonable expectation of privacy in an e-mail address associated in any way with my employment. I am also acknowledging that I am aware of who else in my household may intercept Electronic Communications (for example, family members and roommates) and I have taken all precautions to eliminate others from accessing my Electronic Communications. I am authorizing PPS to transmit Electronic Communications to any e-mail address I provide to PPS.