::Centennial Law - Debtor Relief FR::

DEBTOR RELIEF

The information you submit on this form is completely confidential, privileged, and protected, and will not be shared with anyone without your express written permission.

Debtor Relief Enrollment:

Optional fields are marked*

Your name:
Telephone number:
Alternate number:*
Street address (or P.O. box)
City, zip code:
State:
Email address:
Confirm email address:
Fax #:*
If we need to call you, the best time is:

How many debts are you enrolling?:

Please use the following text field to enter the name and telephone number of the creditor or collection company for each debt you are enrolling (up to five). We will contact each of them with a letter of represenation that will immediately stop any collection calls. We will then verify the debt, confirm compliance with federal laws, and negotiate to reduce your balances/repayment terms. If additional information is necessary, we will inform you.

You will receive an invoice by email for the debt relief enrollment fee of $55.00 (payable in two monthly payments of $27.50). ***DO NOT SUBMIT THIS FORM UNLESS YOU INTEND TO PAY THE FEE.*** By submitting this form you are agreeing to pay the fee. Payment may be made online or by mailing in a check or money order. You will receive an email from the paralegal or legal assistant handling your case with contact information so that you may ask any questions you may have about the handling of your accounts.