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Debt Negotiation Form
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with one of our credit negotiators within 72 hours!
Your Information
Your Name
Your Address
Your City
Your State
Your Zip Code
Your Phone
Your Fax
Your Email Address
1.
Are You Inquiring for you Individually?
Yes
No
2.
Are You Inquiring for your Business?
Yes
No
3.
Are You Inquiring for both Individual and Business?
Yes
No
4.
Are you thinking of filing for protection under the United States Bankruptcy Laws?
Yes
No
5.
Have you filed for protection under the United States Bankruptcy Laws?
Yes
No
6.
If you have filed for protection under the United States Bankruptcy Laws, what Chapter Bankruptcy did you file?
Chapter 7
Chapter 11
Chapter 13
7.
Are you currently working with another Professional such as an Attorney, CPA, or Consumer Credit Counciling company?
Yes
No
8.
If you said Yes to # 7, Please elaborate.
9.
Are you currently 18 years old or older?
Yes
No
10.
How did you hear about our service?
Submit this form for a No Obligation Phone Interview
with one of our credit negotiators within 72 hours!
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Allied Collection Resources
1200 W. University Dr - McKinney, TX 75069
Local:
972-562-7157
Toll Free:
866-490-6989
Fax:
469-519-2384
Email:
Niles@AlliedCollection.com
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