Debt Explanation

Why You Haven't Paid

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

Name^*

Address 1^*

Address 2

City^*

State^*

Zip^*

Email^*

By providing this email I am authorizing CCB to Contact me via my Email.

Phone^*

Day/Work Phone

Cell Phone

Account Number (if known)

Why you haven't paid OR why the account should not have been turned over to collections?

Please tell us when you'd be able to pay or what you could pay.^*