Submit Creditors

Please read the Instructions below the form before you begin.

    Creditor Name (required)

    First Address Line (required)

    Second Address Line

    Third Address Line

    City (required)

    State (required)

    Zip (required)

    Acct. No. (last 4 digits only)(ok to say "Unknown")(required)

    Debt made when? (examples: 2013, 2008-2011, unknown, various years)(required)

    Amount owed. (whole dollars, no cents, no periods, no dollar signs, no commas)(example: if you owe $7,146.39, write 7146)(required)

    What for (examples: credit card, medical, loan, student loan, utility, goods/services, lawyer/collection agent for _____, unknown)(required)

    Your three initials (use your same initials for every creditor)(required)

    Instructions for submitting creditors:

    Gather all your bills and records of debts, then fill out and submit one form above for each creditor. If there is a collection agency or law firm involved, fill out one form for the original creditor (showing the amount owed) and another form for the collection agency or law firm (showing $0 as the amount owed). Read the form carefully before you press the submit button, because you will not have a chance to edit the item until you are physically present in our office. Be sure to supply a full address, zip code, and account number for each creditor or collection agency. Amounts can be estimates. Dates can be “various” if not exactly known.

    If a creditor has given you an address for bankruptcy notices in the past 90 days, use that address; otherwise, if you have a “customer service” or “customer inquiries” address, use that; otherwise, use a “payments” address.

    You may submit your creditors in more than one session, as long as you always use the same three identifying initials. Do include all creditors, even ones that you intend to keep paying, even family.

    If you are having trouble remembering your creditors, you can get a free instant credit report that will list many of your creditors at

    Important: After you initially deliver your workup documents to us, please use plain e-mail to rather than this method if you need to send us additional creditors; otherwise, we will not know that you have sent them.