Credit Grantor/Client Information:

Debtor Information:

Debt Verification:

So as to allow Law Offices of Gary A. Bemis to verify and resolve this debt as quickly and expeditiously as possible, we require copies of the following documents (if applicable) prior to engaging in any collection efforts on behalf of Creditor/Client:

1. Original contract, note, or credit application
2. Relevant purchase orders on underlying transactions
3. Relevant invoices for underlying transactions
4. Relevant Bill of Lading/Proof of Shipping for underlying transactions
5. Complete Statement of Account

Document Attachment:

Please attach the requested documents here:





Need to upload more than 5 attachments? Please send via email once we have confirmed receiving your account.

Credit Grantor/Client Narrative:

Please briefly describe the nature of the debt, including all relevant dates:

By submitting this form you are designating Law Offices of Gary A. Bemis As your Authorized Agent for the collection of this debt.