
Principal Office: Dallas Texas: (214) 670-9989 Toll Free: (866) 670-9989

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Potential Case Submission Form (Debt Collection)

No attorneys' fees, court costs, or expenses unless you recover.

(Texas residents only)

Please provide the following information, click the "Submit Form" button at the bottom, and our law firm will contact you regarding your potential case. The Law Offices of Dean Malone, P.C. and its attorneys do not hereby agree to take the submitted case, but rather will only do so through a written agreement with a prospective client.

What is the name of the creditor (the company to whom you owe the debt)

What type of debt is owed?

How much is owed?

What is the name of the collection agency or collection lawyer?

Have you or someone you know ever worked for a collection agency?

Yes No

How has the collection agency or collection lawyer contacted you (select all that apply):

Mail
Telephone
In-person
E-mail
Through relatives
Through friends
Through employer

Please state in detail all of the things that the collection agency or lawyer has told you will happen if you do not pay the debt.

What has the collection agency or collection lawyer said or done that you feel is improper, harassing, or that might violate the law?

Date of incident/occurrence

Please provide the following contact information:

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State	Texas
Zip Code
Work Phone
Home Phone
FAX
E-mail
Confirm E-mail

Are you currently involved in a bankruptcy proceeding?

Yes No

What is your county of residence?

Is there any additional information which you would like to provide?

Security test. Please identify the pictures:*

Law Offices of Dean Malone, P.C., Founders Square, 900 Jackson Street, Suite 730, Dallas, Texas 75202 Telephone: (214) 670-9989

Website and all pages and contents are copyright 2003-2010 by Law Offices of Dean Malone, P.C., unless otherwise noted. All rights reserved.

This website is for general information only regarding some causes of action and remedies potentially available under certain circumstances and is not, nor should it be construed as, legal advice. Any person who believes that he or she potentially has a legal claim should contact a licensed attorney immediately for a legal opinion. The Law Offices of Dean Malone, P.C. and its attorneys do not hereby establish an attorney-client relationship with anyone, but rather will only do so through a written agreement between it and a prospective client.

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