April 10, 2006

Case Number:

County where judgment received:

Contact Information:

Name: F M/I L

Street Address:

City: State: Zip:

Phone: (Format 000-000-0000) Ext:

E-mail:

Please check what information you have regarding this account:

Original Credit Application

Original Contract

Debtor's Social Security Number

Debtor's Drivers License Number

Debtor's Current Address

Debtor's Employment Information

Copies of Previous Payments

Copy of Judgment

Copy of Recorded Abstract

Original (or copy) Case File

NOTES: Please briefly describe what has transpired up to today's date including before court.