800-354-3863

1757 Pilot Knob Road
P.O. 144
Kattskill Bay, NY 12844

518-366-5111

Acquisition & Funding Services (AFS)

Confidential Information Request Form

(AFS understands the critical importance of the confidentiality of your company's information and this correspondence. This information will NEVER be shared with another party without the written consent of the submitter of this information. This information is provided by you for the sole purpose of an initial introduction to AFS and will be held in the strictest of confidence.)

Please complete the following information about your company and your interests for a confidential evaluation.

Please contact me by email
Please contact me by phone

How did you hear about AFS
(Hold Ctrl button to select more than one interest)
Your Company
Who should we contact?
Your Title
Contact Phone
Best Time to Contact
Address
Contact E-mail
Company Website
Primary Interest
(Hold Ctrl button to select more than one interest)
Years in Business
# States in Which You Operate
Ave. # Accounts Generated Monthly 
Total # of Accounts Owned
* Residential
* Commercial
* Fire
Total Monthly RMR
Types of Equipment Owned
Other pertinent information
AFS should know about  your business 
Comments/Goals/Timelines/Expectations

 

Acquisition & Funding Services
1757 Pilot Knob Road
PO 144
 Kattskill Bay, NY 12844

RoryRuss@Roadrunner.com

Tele # (24/7 availability) 800-354-3863
Cell # (24/7 availability) 518-366-5111
FAX # 518-656-9760