Debt Settlement Letter to Creditor 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 creditor you’re trying to settle a debt with.* Please enter the creditor’s 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 the account number associated with the debt you’re trying to settle.* Please thoroughly describe your financial hardships or other significant reasons why you were unable to pay your debt and why it should be deleted (e.g., a loss of income or medical emergency)* Please enter the amount you are willing to pay to settle this debt.* Please enter the date by which you plan to send your settlement offer payment.* Your Email Address*
