Remember to keep a copy of this for your own records with the date it was sent.  Also log any calls you receive and the information that was exchanged.


Your Name
123 Your Street Address
Your City, ST 01234

ABC Collections
123 NotOnYourLife Ave
Chicago, IL

Date: _________

Re: Acct # XXXX-XXXX-XXXX-XXXX  (Fill in account number)
To Whom It May Concern:
This letter is being sent to you in response to your attached letter.  (If you have nothing in writing use the phrase "recent communication")
This is not a refusal to pay, but a notice that your claim is disputed.
Under the Fair Debt Collections Practices Act (FDCPA), I have the right to request validation of the debt you say I owe you. I am requesting proof that I am indeed the party you are asking to pay this debt and that there is some contractual obligation which is binding on me to pay this debt.
Your legal staff will agree that compliance with this request is required under the laws of (State name) and Federal Statutes.
In addition to the questionnaire below, please attach copies of:

Agreement with your client that grants you the authority to collect on this alleged debt or proof of acquisition by purchase or assignment.

Agreement that bears the signature of the alleged debtor wherein he or she agreed to pay the creditor.

Please also be advised that this letter is not only a formal dispute, but a request that you cease and desist any and all collection activities.

I require compliance with the terms and conditions of this letter within 30 days or a complete withdrawal, in writing, of any claim.
In the event of noncompliance, I reserve the right to file charges and/or complaints with appropriate County, State & Federal authorities ,the BBB and State Bar associations for violations of the FDCPA, FCRA, and Federal and State statutes on fraudulent extortion .
I also hereby reserve my right to take private civil action against you to recover damages.




Debt Validation Form

Questionnaire to be returned :

Account #: ____________________

Original Creditor's Name: _________________________________

Name of Debtor: ______________________________________

Address of Debtor: ___________________________________

Balance of Account: __________________________________

Date you acquired this debt: _________________________

This Debt was: assigned ___purchased___

Please indicated any credit bureaus to which you have reported on this account:

Experian ______

Equifax ______

TransUnion _____