Service Rep: Company:

FAIR DEBT COLLECTION PRACTICES ACT QUESTIONNAIRE

Client Name: Collector Name:
DOB: Account Number:
Address: Collector Phone Number(s):
City: Last Payment Made:
State: Primary Card Issuer:
Zip: Client Number(s) Called:
County:
Phone:
Cell:
Email:    
Comments:

Office: (714) 633-2130

Toll Free: (877) 204-6306

Fax: (877) 235-5905