1100 Town and Country Rd, Suite 1250
Orange, CA 92868
Tel: (619) 810-7490
Fax: (619) 374-7337
401 N. Michigan Avenue, Suite 1200
Chicago, IL 60611
Tel: (312) 242-1849
Fax: (312) 242-1841
Attorneys at Law
I - Your Contact Information
Your Telephone Number:
Your Email Address:
II - The Collection Agency’s Information
Name of Collection Agency calling you:
What is the telephone number of the collection agency:
What is the debt that they are trying to collect:
III - What is the Collection Agency Doing?
1- Is the collection agency calling your work phone?
1(a)-If yes, did you tell the collection agency not to call your work phone?
2- Is the collection agency calling your friends, family, or neighbors?
2(a)- If yes, did any of your friends, family, or neighbors ever speak
to the collection agency?
2(b)- Who did they call? When?
3- Did the collection agency tell anyone that you owe a debt?
3(b)- Who did they tell? When?
4- Are you represented by an attorney to file bankruptcy?
4(a)- If yes, did you tell the collection agency that you were represented by
4(b)- When did you tell the collection agency about your attorney?
4(c)- List each time the collection agency called you after that:
5- Did the collection agency ever threaten to put a lien on your house, garnish your
wages, or attached your bank account?
5(a)- If yes, what did the collection agency threaten to do?
5(b)- When did they make the threat?
6- What else did the collection agency do that you considered harassing, intimidating,
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