*
*
*
*
*
*
*
 

Please specify the following information for the collection agency who has been communicating with you. PLEASE USE SEPARATE FORMS FOR EACH COLLECTION AGENCY, IF MULTIPLE.
 
*
*
*
*

Please check all that apply to the above creditor only.
 
 
 
 
 

If Currently in litigation please provide the following:
 
 
 
PLEASE READ CAREFULLY
NOTICE: This office does not represent you with regard to the matters set forth by you herein in this information sheet or discussed during your consultation unless and until, both you and the Attorney execute a written Agreement for Representation and the agreed upon retainer fee is received by the Attorney. Please be advised, that any and all existing due dates, deadlines, statutory obligations and/or rights that may be related to any matters addressed above, will be solely your responsibility, until and unless we have expressly in writing agreed to represent your interest.
At this point, our office does not agree to represent you. This includes not representing you with regard to the matter set forth by you on this information sheet, nor any other matters you may discuss with the Attorney during your consultation.
If your legal problem(s) involve a potential lawsuit, it is important that you realize a lawsuit must be filed within a certain period of time called a Statute of Limitations. Therefore, the Attorney strongly urges you to immediately consult with another attorney to protect your rights.
The Attorney’s decision not to represent you should not be taken by you as an expression regarding the merits of your case.
 
*