Consumer Response Form

Choose Company Affiliation:*


What is the nature of your issue?

Complaint about original creditor
Complaint about CCC
Compliment/Other


Todays Date:

Account/Case/EDP#:



Creditor:


Contact Information


First Name:*

Last Name:*

Address:

City:

State:

Zip:

Phone:*

Please Explain:


Thank you. The FDCPA requires us to site the following disclosure on all of our written communications: “This is an attempt to collect a debt by a debt collector and any information provided will be used for this purpose.”