Debt Settlement Counteroffer Letter Please enter your full name.* Please enter your current address. Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Please enter your home or mobile phone number.* Please enter today’s date.* Please enter the name of the debt collector or creditor you’re sending a counteroffer.* Please enter the address of the debt collector or creditor you’re sending a counteroffer. Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Please enter the account number associated with the debt you’re trying to counteroffer.* Please enter the settlement offer amount that the debt collector or creditor submitted to you.* When did the debt collector or creditor send you their settlement statement and offer?* Please thoroughly describe your financial hardships or other significant reasons why you are unable to pay the proposed settlement amount (e.g., a loss of income, a medical emergency, etc.)* Please enter the amount you are willing to counteroffer or the amount you are willing to settle your debt for.* Please enter the total amount or current balance of the debt that’s owed.* Please enter the date by which you plan to send the counteroffer payment.* Your Email Address*
