Referral Intake Form | Bank Collection and Recovery Software

Prospect Intake Form

Fiserv DNA Referrals

Required Information

Financial Institution(Required)

Primary Contact Name:(Required)

First Last

Title(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Current Core(Required)

DNA hosted or on premise?(Required)

Fiserv Sales Rep Name(Required)

Fiserv Sales Rep Email(Required)

Other Information if available

Current collections software

Number of Collectors:

Collections Pain Points

Size of portfolio

What is the portfolio make up?

Core short list date:

Select Core date:

Ink date:

Target live date:

Consultant firm/information

IMPORTANT: All proposals from IBS will include DNA’s real time connectivity; if this is an existing DNA FI, please ensure that is accounted for on the Fiserv side in the proposal or let us know if that should not be included.

Thank you for your continued partnership and collaboration.

This field is for validation purposes and should be left unchanged.

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Prospect Intake Form

Required Information

Other Information if available

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