Telephone:                  Email: 

Judgment Information:

Case Number:  (if known)

City Your Judgment was Issued:      

Approximate Date of Judgment:      

Approximate Amount of Judgment: 

First AND Last Name of the Debtor:  

Last Address You Have For the Debtor: 

Were you represented by an attorney?  Select Yes No

Did the Debtor appear in court or is it a default judgment? (select an option below)

Yes, the Debtor appeared in person or by attorney.

No, the Debtor did not appear in court.

Have you tried to collect this judgment? (select an option below)

I have tried to collect this judgment myself.

I have had an attorney, collection agency, or other company try to collect this judgment.

I have not tried to collect this judgment nor has anyone else.

Amount of Judgment Collected to Date:  (if applicable)

Please describe the case.  Be brief but thorough.
 

Is there anything you know about the debtor that may be helpful?