Date Name and Address of collection agency Re: Acct # 000-000-000-000 To Whom It May Concern: This letter is being sent to you in response to your attached letter. This is not a refusal to pay, but a notice that your claim is disputed. This is a request for validation made pursuant to the Fair Debt Collection Practices Act. Please complete the attached form and follow its instructions and your claim will be processed as soon as this information is received. Please be advised that I am not requesting a "verification" that you have my mailing address, I am requesting a "validation"; that is, competent evidence that I have some contractual obligation to pay you. You should also be aware that sending an unsubstantiated demand for payment though the United States Mail System might constitute mail fraud under federal and state law. You may wish to consult with a competent legal advisor before your next communication with me. Please also be aware that if any negative mark is found on my credit reports from your company or any company that you represent, this will result in my filing an immediate lawsuit against you and your client for 1) Violation of the Fair Credit Reporting Act, 2) Violation of the Fair Debt Collection Practices Act, 3) Defamation of Character, 4) Negligent Enablement of Identity Fraud. Pending the outcome of my investigation of any evidence that you submit, you are instructed to take no action that could be detrimental to any of my credit reports. I suggest you and <insert name of original creditor> get your records in order before I have to target you for legal action. Best regards, <insert your name> Cc: <insert name of lawyer>, Esquire (note: just make up a name for the lawyer, just let them think you did it for good effect) Page 2 CREDITOR DISCLOSURE STATEMENT Name & Address of Creditor: _______________________________________________ Name of Debtor: ____________________Acct #: __________________________ Address of Debtor: ________________________________________________________ Amount of Debt purported to be owed: _________ Date it became payable: ___________ Was this debt assigned to the collection agency or purchased? ______________________ Amount paid if purchased: __________ Commission for the collection agency if successful with assigned debt: _________ Please attach a copy of the agreement with your client that grants you the authority to collect on this alleged debt. Please attach a copy of any agreement that bears the signature of the alleged debtor wherein he/she agreed to pay the creditor. Please attach copies of all statements while this account was open. Have any insurance claims been made by any creditor regarding this account? yes / no Have any judgments been obtained by any creditor regarding this account? yes / no Have any negative trade lines been reported to any credit reporting agencies regarding this alleged debt? If so, please name the credit reporting agencies. _______________________________________________________________________ Please provide the name and address of the bonding agent for the collection company <insert name of collection agency> in case legal action becomes necessary. _______________________________________________________________________ ____________________________________ ________________ Authorized signature for creditor date Please return this completed form and attach all assignment or other transfer agreements which would establish your right to collect this debt. Your claim cannot be considered if any portion of this form is not completed and returned with the required documents. This is a request for validation made pursuant to the Fair Debt Collection Practices Act. If you do not respond as required by this law, your claim will not be considered and you may be liable for damages for continued collection efforts. Please allow thirty days for processing after receipt of your request.