Is your debt personal debt or business debt?
Personal
Business
Don't Know
The name of the collection agency that is harassing you is: (can't be original lender - only collection agency or collection lawyer):
The person at the collection agency that is calling you or sending you letters is: (if you don't know, put "don't know.")
The phone number of the collection agency and/or the address (where they want you to send the money) is:
Did the collection agency ever call you before 8:00AM in the morning, or after 9:00PM?
Yes
No
Don't Know
Did the collector ever forget to start a phone call by telling you that they were "a debt collector calling to attempt to collect a debt?"
Yes
No
Don't Know
Did the collector ever imply that they were an attorney when in fact they are not an attorney?
Yes
No
Don't Know
Did the collector ever threaten to sue you?
Yes
No
Don't Know
Did the debt collector contact you AFTER you told them you were represented by an attorney? (i.e. your bankruptcy attorney)
Yes
No
Don't Know
Did the debt collector ever contact you at work AFTER you told them you were not allowed to get calls at work?
Yes
No
Don't Know
Has this debt collector ever contacted anyone other than you or your spouse?
Yes
No
Don't Know
Did the collector ever tell you that non-payment would result in imprisonment or garnishment, or that they would take your belongings, or place a lien on your house?
Yes
No
Don't Know
Did the collector ever use profane language with you or anyone else?
Yes
No
Don't Know
Did the collector ever threaten to physically harm you or your property?
Yes
No
Don't Know
Did the collector ever do anything else to harass, oppress, or abuse you or anyone you know?
Yes
No
If Yes, please describe:
