- Jul 1, 2004
- 4,415
- 0
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w/ this attached:
CREDITOR/DEBT COLLECTOR DECLARATION
Please provide all of the following information and submit the appropriate forms and paperwork within 30 days from the date of your receipt of this request for validation.
Name and Address of Alleged Creditor:______________________________________________________
Name on File of Alleged Debtor: _____________________________________________________________
Alleged Account #: _____________________________________________________________
Address on File for Alleged Debtor: ____________________________________________________________
Amount of alleged debt: _____________________________________________________________
Date that this alleged debt became payable: _____________________________________________________
Date of original charge off or delinquency:___________________________________________________
Was this debt assigned to debt collector or purchased? ____________________________________________
Amount paid if debt was purchased: ___________________________________________________________
Commission for debt collector if collection efforts are successful: ____________________________________
- Please attach a copy of the agreement with your client that grants <get company?s name> the authority to collect this alleged debt.
- Please attach a copy of any signed agreement debtor has made with debt collector, or other verifiable proof that debtor has a contractual obligation to pay debt collector.
- Please attach a copy of any agreement that bears the signature of debtor, wherein he/she agreed to pay creditor.
- Please attach copies of all statements while this account was open.
Have any insurance claims been made by any creditor regarding this account? YES NO
Have any judgments been obtained by any creditor regarding this account? YES NO
Please provide the name and address of the bonding agent for (Name Of Debt Collector), in case legal action becomes necessary: _____________________________________________________________
______________________________
Authorized Signature For Creditor
______________________________
Date
You must return this completed form along with copies of all requested information, assignments or other transfer agreements, which would establish your right to collect this alleged debt within 30 days from the date of your receipt of this letter. Your claim cannot and WILL NOT be considered if any portion of this form is not completed and returned with copies of all requested documents. This is a request for validation made pursuant to the Fair Debt Collection Practices Act. Please allow 30 days for processing after I receive this information back.
CREDITOR/DEBT COLLECTOR DECLARATION
Please provide all of the following information and submit the appropriate forms and paperwork within 30 days from the date of your receipt of this request for validation.
Name and Address of Alleged Creditor:______________________________________________________
Name on File of Alleged Debtor: _____________________________________________________________
Alleged Account #: _____________________________________________________________
Address on File for Alleged Debtor: ____________________________________________________________
Amount of alleged debt: _____________________________________________________________
Date that this alleged debt became payable: _____________________________________________________
Date of original charge off or delinquency:___________________________________________________
Was this debt assigned to debt collector or purchased? ____________________________________________
Amount paid if debt was purchased: ___________________________________________________________
Commission for debt collector if collection efforts are successful: ____________________________________
- Please attach a copy of the agreement with your client that grants <get company?s name> the authority to collect this alleged debt.
- Please attach a copy of any signed agreement debtor has made with debt collector, or other verifiable proof that debtor has a contractual obligation to pay debt collector.
- Please attach a copy of any agreement that bears the signature of debtor, wherein he/she agreed to pay creditor.
- Please attach copies of all statements while this account was open.
Have any insurance claims been made by any creditor regarding this account? YES NO
Have any judgments been obtained by any creditor regarding this account? YES NO
Please provide the name and address of the bonding agent for (Name Of Debt Collector), in case legal action becomes necessary: _____________________________________________________________
______________________________
Authorized Signature For Creditor
______________________________
Date
You must return this completed form along with copies of all requested information, assignments or other transfer agreements, which would establish your right to collect this alleged debt within 30 days from the date of your receipt of this letter. Your claim cannot and WILL NOT be considered if any portion of this form is not completed and returned with copies of all requested documents. This is a request for validation made pursuant to the Fair Debt Collection Practices Act. Please allow 30 days for processing after I receive this information back.
