Sent certified, return receipt mail:  Number ______________________



TO:                              [Credit Issuer]                 FAX


ACCOUNT NO.                                      REFERENCE NO.


FROM:      [Your Name]


During a discussion on (date) with (name of individual) who holds the title of _____ with your company, the following items were discussed:


            Summarize the points using bullet points if possible. For example



Since I did not receive a letter of clearance, I am sending this confirmation of conversation. It is assumed that if you do not dispute this correspondence within 10 days that the above information is true and accurate and that my records have been cleared. You are to send any corrections to me via certified mail so that you may show that I received the correspondence or it will be concluded that it was not delivered or sent.


Please notify all collection agencies that you may have sent this account to. Be advised that reporting these items to the credit bureaus as collection items or continuing to pursue these debts from me would be considered a violation of the Fair Credit Reporting Act.  



Victim Name                                                               Social Security Number


Victim Address




Victim Phone                                       Fax                                          Email



Signed:  _______________________________________________    Date_________________