Whether or not Centennial Law Offices represents you in any matter, the information you submit on this form is completely confidential and will not be shared with anyone without your written permission. It is protected by the attorney-client privilege and cannot be obtained by anyone.

The steps to obtaining relief and possible compensation from collection call harassment are quick and simple:

1.) Submit a report (below).

2.) The report will be reviewed by an attorney within 24hrs, 7-days week. If it is determined that you are a victim of harassing calls from debt collection company, you will be notified and receive a representation agreement.

3.) Once you have agreed to representation (you may do so immediately by email), we will act very quickly to stop the harassing calls. We will then take action to recover for you (up to $1,000 plus any actual damages) from the offending collection company. You may recover $1,000 under federal law regardless whether you owe debt or not. Our legal fees are recovered from the violating debt collector and are not subtracted from the up to $1,000 you may obtain under the law. You will pay no out-of-pocket charges for getting help. You only stand to recover up to $1,000 or not. In no event will you be charged anything for debt collection violation/harassment representation.

If you have any questions about submitting this form or obtaining representation, call (888)504-8817 or email us at Contact@centenniallawoffices.com. Emails received during business hours are usually responded to within 3-hours.

Report Telephone Harassment:

Mandatory fields are marked*

Your name:*
Telephone number:*
Alternate number:
City:
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Email address:*
Confirm email address:*
Fax #:
What is the best time to call you?:	Select Morning Afternoon Evening
Your phone number that the collection company is calling:
Approx. date when the calls began:
Approx. number of calls received in total:
Name of collection company (if known):
Phone number of collection company (if known):
Please describe in detail the nature of the calls. The more detail you can provide, the better we can assist you. Examples of helpful details are exact dates of calls, names persons whom you've spoken with, the name of the person they are trying to contact, and so on. Please note any effort made on your part to stop the calls (although it is not your obligation to make such an effort):*
Do you actually owe the debt the collection company is contacting you about?*	Select No Yes Not sure