Consumer Info Form

Consumer Info Form

Thank you for contacting the Customer Service Department. You must accept the Terms and Conditions above to continue.
What are your needs today?*

Consumer*

First NameLast Name
Email*
example@example.com
Do you consent to Carter-Young, Inc. using this email address to communicate with the you about the debt.

Yes
Phone Number
By clicking “Accept”, I expressly consent to Carter-Young, Inc.,to send me information about the debt(s) – including texts and calls made using an automatic telephone dialing system or pre-recorded or artificial voicemessages to the number I have provided above. Accepting this consent is not required.

Accept
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Carter-Young Account Number
Creditor Name*
Preferred Method to Receive Validation and/or investigation results if applicable?*
Reason for Dispute*
Questions or Comments
Exact Amount Disputed*
Do you have documentation to substantiate the basis of this dispute?*

YesNo
What is your proposed payment solution?*
How would you like to provide the document(s)

Upload FileTake a pictureBoth

Please upload any document(s) that substantiate the basis of your dispute*

Cancelof
Take Photo of any document(s) that substantiate the basis of your dispute*
Name of the person Carter-Young is attempting to contact*
Have you received mail from us?*
To what address did we send the mail?

Street Address

Street Address Line 2

CityState

Zip Code
Have you received phone calls from us?*
What phone number did we call?*
Please enter a valid phone number.
Have you received e-mail from us?*
What is the e-mail address?*
example@example.com
Please be aware that disputing a portion of this debt does not invalidate the remaining amount and Carter-Young will assume that any amount undisputed is a valid debt.
Case Number*
Attorney Name*
Name of Law Firm
Attorney Phone Number
Reporting Agency
Date Last Reported*

MonthDayYear
Date
Name of Credit Bureau (check all that apply)*

ExperianEquifaxTransUnion
Why is it an error to list this debt on your credit report?*
Attorney Email
example@example.com
Attorney Address*

Street Address

Street Address Line 2

CityState

Zip Code
Attorney Fax Number
Location of Death
Date of Death*

MonthDayYear
Date
Name of Executor
Please verify that you are human*
Disputed?

YesNo
CYI File #
Should be Empty:

Please be aware that disputing a portion of this debt does not invalidate the remaining amount and Carter-Young will assume that any amount undisputed is a valid debt.