Debtor Information form

PLEASE FILL OUT THE FORM ON THE RIGHT

WE UNDERSTAND YOUR PREDICAMENT

Both your creditors, insurance carriers and our Florida debt collection lawyers understand that in all probability, you did not intend to fall into delinquency.  You may have been the victim of circumstances:
you lost your job; you were demoted; you were involved in an auto accident; you have suffered from unexpected medical expenses; you are going through a divorce or other family crisis; you are a hurricane victim; or you simply have not had enough income to meet your obligations.

CONTACT US TO MAKE VOLUNTARY PAYMENT PLAN AGREEMENTS

We encourage you to contact us, to make voluntary payment plan arrangements.  Your plan could reduce, stop, or prevent negative consequences of your nonpayment, including but not limited to the following:

  • litigation and related legal fees
  • required depositions and court appearances
  • paycheck garnishment
  • bank account garnishment
  • other types of garnishment proceedings
  • seizure of personal property

MAKE A REPAYMENT PLAN THAT WILL NOT LEAD TO DEFAULT

In the event that you default on the agreed-upon repayment plan, we may have to resume the litigation process.  Although we are experienced trial lawyers, we are as eager as your creditor is to help you avoid the stress, expense, and loss that could result from further collections litigation.

COME TO THE BARGAINING TABLE VOLUNTARILY FOR THE BEST OUTCOME

If you are ready to come to the table voluntarily or have any additional questions, contact us with the understanding that any information obtained from you through this web site or by any other means can and will be used for collection purposes.

  • Telephone Contact: (800) 807-3334 or (321) 636-4861
    Press option 2 for the Collections Department
  • Facsimile number: (321) 574-5902
  • Mailing address for Payments:
    P.O. Box 236187
    Cocoa, FL 32923
  • Mailing address for Correspondence:
    1980 Michigan Avenue
    Cocoa, FL 32922
  • Payment options: You may pay by phone through a Recovery Specialist by your checking account, Visa, Discover, American Express or MasterCard.  Western Union or in-person payments are also available.

Please Note: we DO NOT accept cash payments at any of our locations


This is YOUR information or the company or organization that owes our client money

    Debtor Information

    * Your Name (required)

    Company or Organization Name
    (If you are completing this form on behalf of a company or organization please enter the name below)

    * Address (required)

    * City (required)

    State

    * Zip Code (required)

    * Phone: (required)

    Fax:

    * Your Email (required)


    Creditor Information

    * Name: (required)

    Address:

    City

    State

    Zip Code


    Debt Information

    This is information regarding the actual debt that you owe to our client

    * Amount Owed (required)
    How much money do you owe to our client?

    Age of debt (required)
    How long have you owed this money to our client?

    * Proposed Settlement (required)
    What type of settlement do you propose to retire this debt promptly? Please indicate any terms (duration and amount of incremental payment); reduced amount request or any other issues you feel are relevant for our client to consider. Be aware that making this request for consideration DOES NOT obligate our client in any way whatsoever to accept your proposal.

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