REQUEST FOR VALIDATION

[Your Name]
[Address]
[City state ZIP]

[Collector]
[Address]
[City State ZIP]
[Phone number]

[Date]

Re: __________________   Account Number: __________________

Greetings:

Thank you for your recent inquiry.  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.  I dispute your debt collection-related allegations, deny the same, and demand strict proof and verification thereof. 

Please limit your communication with me to writing only.  If I receive any telephone calls from your company, I will consider them to constitute harassment.  Please be advised that unwanted telephone calls are a class 1 misdemeanor in this state and I will file a complaint against the caller with the attorney general’s office.  I maintain a telephone log of each phone call and in some cases, make an audio recording when necessary.

Be advised that you have the right to remain silent.  If you ignore this notice and contact me by telephone, you and your employees agree to allow me to make an audio recording of our conversation and you and your employees agree to allow the recording and any other information obtained to be used against you and your employees in a court of law.  I will accept only your written communication.

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 unsubstantiated demands for payment through 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.

Your failure to satisfy this request within the requirements of the Fair Debt Collection Practices Act will be construed as your absolute waiver of any and all claims against me, and your tacit agreement to compensate me for costs and attorney fees.

Best regards,

[Subscriber]

CREDITOR DISCLOSURE STATEMENT

Name and Address of Collector (assignee):

____________________________________________________________________________

Name and Address of Debtor:

____________________________________________________________________________

Account Number(s):

____________________________________________________________________________

What are the terms of assignment for this account?  You may attach a facsimile of any records relating to such terms.

____________________________________________________________________________

____________________________________________________________________________

Have any insurance claims been made by any creditor or assignee regarding this account?

Yes / No

____________________________________________________________________________

Has the purported balanced of this account been used in any tax deduction claim?

Yes / No

____________________________________________________________________________

Please list the particular products or services sold by the collector to the debtor and the dollar amount of each:

____________________________________________________________________________

____________________________________________________________________________

Upon failure or refusal of collector to validate this collection action, collector agrees to waive all claims against the debtor named herein and pay debtor for all costs and attorney fees involved in defending this collection action.

X________________________________                      _________________

Authorized Signature of Collector                                        Date

Please return this completed form and attach all assignment or other transfer agreements that 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.