Settlement Offer Form First Name:* First Name:* Last Name:* Last Name:* File Number: File Number: Last 4 Digits of your SSN (optional): Last 4 Digits of your SSN (optional): Address 1:* Address 1:* Address 2: Address 2:* City:* City:* State:* State:*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP:* ZIP:* Phone Number*: Phone Number*: Email*: Email*: Settlement Amount Offered:* Settlement Amount Offered:* Additional Info: Additional Info: THIS COMMUNICATION IS WITH A DEBT COLLECTOR AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. *If the phone number you provided is a mobile or cellular device or routed to one, you are expressly consenting and authorizing Couch Lambert Law Firm to contact you on such device with the number you provided.*If the phone number you provided is a mobile or cellular device or routed to one, you are expressly consenting and authorizing Couch Lambert Law Firm to contact you on such device with the number you provided. *If you provided an email address above or in some other communication with Couch Lambert Law Firm, you are expressly consenting and authorizing our Firm to email you at the provided email address.*If you provided an email address above or in some other communication with Couch Lambert Law Firm, you are expressly consenting and authorizing our Firm to email you at the provided email address.