Dispute & Original Creditor Request Form

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Know Your Rights

Understand your rights and what you need to do.

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

Please complete the following Account Dispute Form to dispute a debt electronically. You may also call Cascade Receivables Management, LLC directly at (888) 346-4656 and an agent would be happy to assist you.

    * Denotes required fields

    Your Information

    First Name *

    Middle Name

    Last Name *

    Address 1 *

    Address 2

    Phone Number *

    Email *

    Account/Reference Number

    Type of Debt, if known

    Dispute Details

    Upload Documents

    Please upload any available supporting documents (files must be .DOC, .DOCX, .PDF, .JPG, .PNG; 10MB maximum)

    Signature *
    By sending this form you agree that we may contact you by email, phone and/or text message. For your privacy and protection, please provide us with your personal email address, as work, school or governmental email addresses may be monitored by third parties. You should also be aware that if you provide us with an email of a shared account, third parties may also be able to access your personal information. You may opt out at any time.

    By clicking submit, you are agreeing to the terms and conditions as stated above and attest that the information provided is true and accurate to the best of your knowledge.

    The disclosures below are provided for residents of the states listed. The fact that your state may not be listed does not mean that you do not have similar protections in your state.

    If you live in California: As required by law, you are hereby notified that a negative credit report reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations.

    The state Rosenthal Fair Debt Collection Practices Act and the federal Fair Debt Collection Practices Act require that, except under unusual circumstances, collectors may not contact you before 8 a.m. or after 9 p.m. They may not harass you by using threats of violence or arrest or by using obscene language. Collectors may not use false or misleading statements or call you at work if they know or have reason to know that you may not receive personal calls at work. For the most part, collectors may not tell another person, other than your attorney or spouse, about your debt. Collectors may contact another person to confirm your location or enforce a judgment. For more information about debt collection activities, you may contact the Federal Trade Commission at 877-FTC-HELP or www.ftc.gov.

    Medical Accounts Only:
    Non Profit Credit Counseling Services may be available in your area.

    The California Consumer Privacy Act requires that we inform you that we collect the following categories of personal information from consumers for the purpose of servicing accounts and collecting debts: 1)Personal Identifiers; 2) Categories of Information described in Section 1798.80(e) of the California Civil Code]; 3) Professional or employment related information; and 4) Other information about you that is linked to the personal information in 1,2 or 3 above. For more information or to access this notice in a different format, please see our Privacy Policy at https://cascadehelps.com/ccpa

    If you live in Colorado: FOR INFORMATION ABOUT THE COLORADO FAIR DEBT COLLECTION PRACTICES ACT, SEE https://coag.gov/car Local CO Office address: 7200 S Alton Way Ste B180, Centennial, CO 80112. License number 992615.

    A consumer has the right to request in writing that a debt collector or collection agency cease further communication with the consumer. A written request to cease communication will not prohibit the debt collector or collection agency from taking any other action authorized by law to collect the debt.

    If you live in Connecticut: This collection agency is licensed in Connecticut, License number CCA-1371506 & SFC-1371506.

    If you live in Maine: If you have an issue about the way we are collecting your debt, contact the Maine Department of Professional and Financial Regulation, Bureau of Consumer Credit Protection at 35 State House Station, Augusta, ME 04333, 207-624-8527. License number DCL14555.

    If you live in Massachusetts: NOTICE OF IMPORTANT RIGHTS
    You have the right to make a written or oral request that telephone calls regarding your debt not be made to you at your place of employment. Any such oral request will be valid for only ten days unless you provide written confirmation of the request postmarked or delivered within seven days of such request. You may terminate this request by writing to the debt collector.

    If you live in Minnesota: This collection agency is licensed by the Minnesota Department of Commerce.

    If you live in Nevada (Medical Accounts Only): If you pay or agree to pay the debt or any portion of the debt, the payment or agreement to pay may be construed as: (1) an acknowledgement of the debt by the consumer; and (2) a waiver by you of any applicable statute of limitations set forth in NRS 11.190 that otherwise precludes the collection of the debt. If you do not understand or have questions concerning your legal rights or obligations relating to the debt, you should seek legal advice.

    If you live in New York:  This collection agency is licensed by the Department of Consumer Affairs of the City of New York.

    We are required by regulation of the New York State Department of Financial Services to notify you of the following information. This information is NOT legal advice. Debt collectors, in accordance with the Fair Debt Collection Practices Act, 15 U.S.C. § 1692 et seq., are prohibited from engaging in abusive, deceptive, and unfair debt collection efforts, including but not limited to:

    1. the use or threat of violence;
    2. use of obscene or profane language; and
    3. repeated phone calls made with the intent to annoy, abuse, or harass.

    If a creditor or debt collector receives a money judgment against you in court, state and federal laws may prevent the following types of income from being taken to pay the debt:

    1. Supplemental security income, (SSI);
    2. Social security;
    3. Public assistance (welfare);
    4. Spousal support, maintenance (alimony) or child support;
    5. Unemployment benefits;
    6. Disability benefits;
    7. Workers’ compensation benefits;
    8. Public or private pensions;
    9. Veterans’ benefits;
    10. Federal student loans, federal student grants, and federal work study funds; and
    11. Ninety percent of your wages or salary earned in the last sixty days.

    If you live in North Carolina: This is an attempt to collect a debt. Any information obtained will be used for that purpose. This is a communication from a debt collector. This agency is licensed by the North Carolina Department of Insurance.

    If you live in Tennessee:  This collection agency is licensed by the Tennessee Collection Service Board of the Department of Commerce and Insurance.

    If you live in Utah: As required by Utah law, you are hereby notified that a negative credit report reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations.

    5341 Old Redwood Hwy
    Suite 210
    Petaluma, CA 94954

    Contact Number:
    (877) 753-0010