Creditors Worksheet - Keegan & Co Attorneys, LLC

These sheets are to be used only for Creditors that do NOT appear on your credit report.

Creditors Name:

Address

Street Address City State / Province / Region ZIP / Postal Code

Correspondence address if different from the payment address.

Account Number

Balance Due:

What is the debt for?

What is the name on the account?

When was the debt incurred

Month/Year

through

Month/Year

Is this debt secured by any property

Yes

Description of Secured Property

Is there a cosigner on this debt

Yes

Cosigner's Name

Cosigner's Address

Street Address City State / Province / Region ZIP / Postal Code

Has this debt been sent to a collection agency

Yes

Collection Agency's Name

Collection Agency's Address

Street Address City State / Province / Region ZIP / Postal Code

Has this creditor sued you on this debt

Yes

Court Name

Case Number

If you've been sued, has the creditor filed a lien in Common Pleas Court?