Debt Consolidation Offer – The Cook Law Office

Debt Consolidation Offer

In order to begin settlement negotiations, please fill out the form below. All required fields must be completed for the offer to be submitted.

"*" indicates required fields

Defendant(s) Name*

First

Middle

Last

Suffix

Last 4 of Social Security Number

Case Number

Current Debtor Mailing Address*

Street Address

City

State / Province / Region

ZIP / Postal Code

Country

Contact Phone Number*

Contact Email Address:*

Current Employer Name*

Current Employer Address*

Street Address

City

State / Province / Region

ZIP / Postal Code

Country

Monthly Payment Due Date*

Monthly Payment Offer Amount

Lump Sum Payment Date (Due within 30 days)*

Lump Sum Offer Amount

Special terms offered

Questions

Upload Field for Power of attorney document*

Max. file size: 5 MB.

Power of Attorney Contact Phone and extension*

Power of Attorney Contact email*

This is an attempt to collect a debt and any information obtained will be used for that purpose. This communication is from a debt collector.

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