Account Questions

This is an attempt to collect a debt by a debt collector and any information obtained will be used for that purpose.

Please provide as much of the requested information as possible to facilitate locating an associated account. If Caine & Weiner, is not able to properly identify the account in our system, a reply may not be possible.

Caine & Weiner, Account Number: *

Original Creditor:

Name: *

Company:

Address: *

City: *

State: *

Zip Code: *

Email: *

Phone: *

Fax:

Questions or Comments: *

Terms of Use and Service

I hereby understand and acknowledge that I have received and reviewed this consent and that by proceeding I agree to same.

I hereby expressly consent to be contacted by Caine & Weiner, or anyone calling on its behalf, for any and all purposes, at any physical address, electronic address or telephone number I provide, including any wireless telephone number. I agree that Caine & Weiner, may contact me in anyway, including but not limited to telephone calls, prerecorded or artificial voice or text messages delivered by an automatic telephone dialing system. In addition I hereby confirm that the email address listed above is mine and that I authorize you to contact me either manually or by automatic emailing system to said email address.

Caine & Weiner, is a debt collector.

This is an attempt to collect a debt and any information obtained will be used for that purpose.

By sending this form, you agree to the Terms of Use and Service above.

NEW YORK: New York City Department of Consumer Affairs License Number: 1157930

Please let us know if you have a language preference other than English. A translation and description of commonly
used debt collection terms is available in multiple languages on the NYC Department of Consumer Affair’s website at
www.nyc.gov/dca. Caine & Weiner, has agents available to communicate verbally in Spanish.
Caine & Weiner, does not offer a translation of any communication into languages other than English.