Unfair Debt Collection Inquiry

This questionnaire will only be viewed by Attorney Nicholas F. Ortiz and will be kept private and confidential.

Your Contact Information:
Your First Name:
Your Last Name:
City or Town in Massachusetts where you live:
Phone Number (Best one to use to reach you):
Email:
Debt Collector Information:
What is the name of the debt collector that you feel has employed unfair debt collection practices? (Note: Often a debt collector is calling "about" a debt that originally was with another company, like a credit card company. However, the debt collector has its own name, such as "XYZ Recovery Services." The debt collection company's name is what you should submit. If you do not know the name, you can enter the telephone number that the debt collector gave you instead. I may be able to determine the debt collector's identity based on the telephone number.)
For how long has the debt collector been attempting to collect the debt?
Was the debt incurred primarily for personal, family, or household purposes (in other words, was the debt -- even if you dispute it -- alleged to be a personal rather than a business debt)? Personal = Yes; Business = No.	Yes No
Approximately how much does the debt collector state that you owe?	$
Do you dispute the amount or validity of the debt?	Yes No
Have you sent a dispute letter or fax to the debt collector?	Yes No
Has the debt collector contacted anyone other than you and/or your spouse (such as a co-worker, family member, or neighbor) and revealed anything about the debt to them?	Yes No
Has the debt collector threatened to sue you, take your property, invade your privacy, or send law enforcement after you?	Yes No
Estimate how many times within the last month the debt collector has called you and that you have actually talked to the debt collector?
Do you have other debt problems?	Yes No
If it your rights have been violated, do you want to sue the debt collector?	Yes No
If you decide to file suit, are you able to pay a federal court filing fee of $350 within 30 days?	Yes No
If you wish, submit a summary of how you feel you have been wronged by the debt collector. You may also clarify any of the answers you gave to the questions above.