Florida Consumer Collection Practices Act Complaint Form Page 2
ADVERTISEMENT
1
2
3Your name: ________________________________________________________________
Address: __________________________________________________________________
City: _____________________________________________________________________
State: ___________________ Zip Code:
_______________________________________
Telephone: ________________________________________________________________
Collection agency name: _____________________________________________________
Address: __________________________________________________________________
City: _____________________________________________________________________
State: ___________________ Zip Code: ________________________________________
Telephone: ________________________________________________________________
Are you the debtor in the matter about which you are complaining
____Yes ____ No
Would you be willing to testify if this matter goes to a formal hearing? ____ Yes ____No
DESCRIBE YOUR COMPLAINT - Include facts, details, dates, locations, etc. Please attach copies of
collection records, correspondence, contracts, and any other documents that will help support your
complaint. (Use a separate sheet if necessary. Do not write on the back of this form).
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Page 2 of 3
FORM OFR-559-102, Effective 09-09-2015
Incorporated by reference in Rules 69V-180.002 and 69V-180.040, F.A.C.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal