Resolve Your Account - Glasser and Glasser P.L.C.

Name:

File Number:

Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Bank Name:

Employer:

Employer Phone:

E-Mail Address:

May we contact you by your cell phone?
YesNo

May we leave you messages?
YesNo

Please call me to discuss this account with you. The best time to call is

Please call me to discuss payment arrangements and propose to pay per month, starting on

Please call me to discuss the account for a one-time payment of to be paid on

Please call me to discuss resolution of the full balance with a one-time payment of to be paid on

Have you retained an attorney on this matter?

Attorney Name*

Attorney Phone*

We will contact your counsel.

Additional info:

Glasser and Glasser, P.L.C. will review your offer and will contact you with a response. Making an offer will not establish a payment arrangement, or a resolution in full, without express approval in writing from Glasser and Glasser, P.L.C. Thank you for contacting us.

We are currently operating with reduced operational staff during the COVID-19 emergency. By submitting this form, you understand and agree that we may respond to you at your personal email address that you provide. We may respond by e-mail if a call back option is not available.

Note: This communication is from a debt collector. This communication is an attempt to collect a debt. Any information obtained will be used for that purpose.

By clicking the SUBMIT button below:

You authorize Glasser and Glasser, P.L.C., to communicate with you by e-mail at the e-mail address you provided above for the purposes of responding to your request. You understand that any person who has access to the e-mail address you provide may also view the communication.
You confirm that you are not providing a work e-mail address furnished by your employer. We may not be able to respond if the e-mail address you provide has a corporate organization’s domain name.
By clicking the SUBMIT button, you acknowledge an email is being sent that is not secure and can potentially be read by others.