Who is the Requestor? Individual or Company Name that is requesting to have their debt deleted. Requestor's Mailing Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Requestor's Contact Details E-Mail Telephone Who is this Letter being sent to? Dear, What was the Original Amount Owed? $ Original Creditor Who was the Original Creditor? Account Number Do you know the Account Number? Do you know the Account Number? YesNo Enter the Account Number Settlement Amount ($) How much are you willing to pay to have this debt settled? $ This is also known as the "Offer Amount". If accepted by the Creditor, this will be required to be paid immediately. Date Date of this Letter Next Save Save and finish later
