Dispute A Debt

Dispute a Debt

Please complete the form below. Include as much information as possible to help us better understand your dispute.
Please enter your account number found on your statement.
Please enter your account number found on your statement.
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First Name
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Last Name
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Birth Date
MM/DD/YY
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Social Security Number
Social Security Number
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Address Line 1
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Address Line 2
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City
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State
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Zip Code
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Primary Phone Number
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Cellular Phone Number
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Email Address
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Alternate Phone Number
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Preferred Communication Method
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I want to dispute the debt because I think:
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What is your dispute?
Please provide detailed explanation
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*If you have any questions about this form please contact Central Professional Services so that we may assist you.1-800-748-0031
This dispute has been submitted by:
Please enter first and last name
Your Full Name
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