Notice Regarding Creditors Page 2
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1
2REQUEST FOR ACCOUNT INFORMATION FROM CREDITORS
You may use this form to request information about debt owed by you or your spouse.
If so, send to the creditor. DO NOT FILE THIS PAGE WITH THE COURT.
DATE: _______________________________
CREDITOR'S NAME: ________________________________________________________________
CREDITOR'S ADDRESS: _____________________________________________________________
Superior Court of Arizona Mohave County
Regarding:
Case Name: _____________________________________________________
Case Number: ____________________________________________________
Pursuant to Arizona State Law (ARS 25-318), this letter requests the balance and account status of any debt
for which the following individuals may be liable to you. (Arizona law requires that you provide this
information within thirty (30) days of receipt of this letter.)
INFORMATION ABOUT DEBTORS/SPOUSES:
Your Name: __________________________________________________________________________
Your Address: ________________________________________________________________________
________________________________________________________________________
Your Phone Number: ___________________________________________________________________
Your Spouse's Name:
________________________________________________________________
Your Spouse's Address:
______________________________________________________________
INFORMATION ABOUT THE ACCOUNT:
Account Number(s): ____________________________________________________________________
If you have any questions or if I can be of further assistance, please feel free to contact me.
Sincerely,
Your name: ___________________________________________________________________________
Your signature: ________________________________________________________________________
Revised: 11/8/2010
Page 2 of 2
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