Complaint on a Georgia Member Collection Agency or Law Firm
Georgia Collectors Association, Inc.
Roger D. Medlin, Exec Director
Please fax to (706) 937-8278
We must have a signed form in order to investigate a complaint.
Person completing form:
Name: Home Telephone #:
Address: Work Telephone #:
City: State: Zip:
__________________________ _____ _________
To forward your complaint, we will need to give your name to the collection agency you are complaining
Complaint filed against (Company Name): _____________________________
Business Name: ___________________________________________________
Address (number, street, & suite #): ___________________________________
City: State: Zip:
Name of person(s) complaint is filed against:
Have you complained to the company? Yes_____ No_____
By: Telephone_____ Letter_____ In Person_____
The date you complained to the company:
Result of contact (use extra sheets if necessary):
Describe the events of your complaint in the order they happened, as briefly as possible, giving specific names, dates, times, etc., whenever possible. (Use extra sheets if necessary):
What do you want the person or company to do to satisfy your complaint?
READ THE FOLLOWING BEFORE SIGNING BELOW
Keep a copy of this form for yourself. Return this original form to the Georgia Collectors Association at the address or fax number above. The filing of this complaint form is in addition to any of your legal rights and remedies.
By filing this complaint I give my authorization and consent directly to the collection agency against whom this complaint is made to disclose any information regarding me or any account bearing my name to the Georgia Collectors Association authorized staff and counsel for use in the Georgia Collectors Association Consumer Complaint program. I further consent and understand that the content of my complaint will be shared with the collection agency against whom this complaint is made.
I hereby certify under penalty of perjury under the laws of the state of Georgia that to the best of my knowledge all of the above statements are correct.
Your signature Date