FEE SCHEDULE

FOR

WALKER & WEISS, INC.

28%

LESS THAN (1) YEAR OLD FROM THE DATE OF THE LAST INVOICE OR THE LAST DATE OF SALE. COMPANY IS STILL IN BUSINESS, WITH WORKING TELEPHONE NUMBER.

35 %

OVER (1) YEAR FROM THE LAST DATE OF SALE, OR WITH A DISCONNECTED TELEPHONE NUMBER.

50%

FOR ACCOUNTS UNDER $200.00 AND RETAIL (CONSUMER) ACCOUNTS

CLIENT:________________________________________________

ADDRESS:______________________________________________

CITY:___________________STATE:______ZIP CODE:__________

TELEPHONE:____________________FAX:____________________

AUTHORIZED SIGNER:____________________________________

TITLE:__________________________________________________

DATE SIGNED:___________________________________________

NOTE: RECOVERED FUNDS WILL BE DEPOSITED INTO A TRUST ACCOUNT BY WALKER & WEISS ,INC., AND REMITTED TO YOU (OUR CLIENT) ON THE 20^TH DAY OF THE FOLLOWING MONTH AFTER DEDUCTION OF OUR FEE PERCENTAGE. BY AFFIXING YOUR SIGNATURE, YOU AUTHORIZE WALKER & WEISS, INC., TO RECEIVE OR ENDORSE, THROUGH OUR COMPANY NAME, ALL CHECKS AND/OR DRAFTS FOR PAYMENTS OF PAST DUE ACCOUNTS SUBMITTED TO US PER FEE SCHEDULE.

NOTE: IF YOU PLACE AN ACCOUNT THAT WAS PAID PRIOR TO LISTING, OR IF YOU WITHDRAW AN ACCOUNT SUBMITTED, PURSUANT TO THIS AGREEMENT, AFTER WALKER & WEISS, INC., HAS EFFECTED COLLECTION OR BEFORE WALKER & WEISS, INC., DEEMS THE ACCOUNT UNCOLLECTIBLE, YOU WILL BE LIABLE FOR THE FULL FEE WALKER & WEISS, INC. WOULD HAVE EARNED, HAD WE COLLECTED THE WITHDRAWN ACCOUNT IN FULL.

** ON ACCOUNTS WITH RETURN MERCHANDISE VERSUS PAYMENT, HALF RATE WILL APPLY.

N.C. DEPT. OF INSURANCE PERMIT #3261

* WALKER & WEISS, INC. * SUITE B * BOONE, NC 28607 * 800-725-2125 * FAX: 828-263-0717

www.walkerweiss.com

For a downloadable version click here.