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| Contact Information: |
| *First Name: | | |
| *Last Name: | | |
| Address 1: | | |
| Address 2: | | |
| *City: | | |
| *State: |
*Zip: | |
| *Email: | | |
| *First Phone: | | | |
| Second Phone: | | | |
| Third Phone: | | | |
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| Case Information: |
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Describe the harassing, threatening or improper conduct of the debt collector.
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Please provide the name of the collector.
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Are you being contacted at inconvenient locations by a debt collector?
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If yes, please provide details on all such contacts.
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Are you being contacted by phone at inconvenient times like early in the morning or late in the evening?
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If yes, please provide details on all such contacts.
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Is a debt collector discussing your debt with others or contacting people you know about your debt?
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If yes, please provide details on all such contacts.
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Is a debt collector using profanity, threatening you with violence, arrest, wage garnishment or property seizure when attempting to collect your debt?
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If yes, please provide details on all such contacts.
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Are you being contacted by a collector after telling him in writing to stop?
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If yes, please provide details on all such contacts.
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How many times per week are you being contacted by a collector?
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Submitting this form does not establish an attorney/client relationship – that will be established only upon our mutual agreement and execution of an agreement. Weisberg & Meyers, LLC has attorneys admitted to practice in Arizona, California, Colorado, Florida, Illinois, New Mexico, Oklahoma, Oregon, Texas and Washington and works with a nationwide network of consumer advocates in all other states. Accordingly, inquiries/submissions may be referred to and services may be performed by other attorneys associated with Weisberg & Meyers, LLC. As such, information sent in a request for a brochure/information may not be kept confidential and may not be protected by the attorney/client privilege, however, any such information will not be disseminated in any way or for any purpose other than that stated above.
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