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Date
Letter Date
Your Name
Enter your legal name ( Do NOT sign the letter )
Your Address:Street
Your Address:City, State Zip
S.S.N.
we do not collect this info or keep it in any way
Creditor Name
(as gathered from your credit report)
Creditor Address:Street
Creditor Address:City, State Zip
Account Number
(If you do not have the complete number just enter X's)
derogatory condition
(insert a derogatory condition here, such as "I owe $200.00? or "my account was charged off $800")
Initial Letter Dated
The date the initial letter was sent
