Settlement Offer Form

    First Name:*

    Last Name:*

    File Number:

    Last 4 Digits of your SSN (optional):

    Address 1:*

    Address 2:

    City:*

    State:*

    ZIP:*

    Phone Number*:

    Email*:

    Settlement Amount Offered:*

    Additional Info:

    THIS COMMUNICATION IS WITH A DEBT COLLECTOR AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.

    Couch | Lambert