Company or individual Title * Company or Individual you are reporting All the information in Step 1 is on the Company or Individual you are reporting. YOU ARE NOT reporting your personal information here. Name of Company or Individual you are reporting: – If you have more than one Company or Individual named in your report, or if the company goes by more than one name (AKA’s), put the other names in the “Other Name’s” box Name of Company or Individual * Aditional names (AKA's) (optional) What is the Amount of the Debt owed by this company or individual? – Enter the amount that a company or individual owe to you Amount ($) Web address of the Company or Individual on the Internet: – If the Company or Individual is on the Internet and only on-line based, enter a web address below. Web Address Facebook Yelp Google+ Address of Company or Individual you are reporting: – You must enter either a physical street address and/or a web address. – You may enter both, BUT If the Company or Individual is on the Internet and only on-line based, or you don’t have a physical address, you MUST enter their Web address Street Address physical (street) address only, city and state go below City State / Province Zip Code (optional) Country Phone, and e-mail address of Company or Individual you are reporting: – This information is not required, but they are good tools for sympathetic Consumers to let the Company or Individual know how they feel about what they did to you and will only help your situation – This information may also be helpful to other victims reading your Debt Check – The more information you provide, the better. Phone E-mail Address Debt Report To help format our reports to be more easily read: PLEASE…. DO NOT use ALL CAPITAL LETTERS, it makes it hard to read. DO NOT indent paragraphs. DO NOT write your report all in one paragraph. Use 2 or 3 sentences to each paragraph and leave a space between each paragraph. DO NOT sign your name, or include any e-mail addresses in the report. Your Information This will automatically place your display name, your City and State at the very end of your report and will add credibility to your DEBTcheck report. If you are afraid of retaliation and/or would like to remain anonymous, please change your first name, city, and state here. Display Name City State Country Write your report in the following text box DO NOT sign your name, or include any e-mail addresses in the report. Use the boxes below to automatically put your FIRST name, City and State at the very end of your Debt Check Method of Payment on Transaction Dear Consumer, There are special protections for you if you have used a credit card, especially in an online transaction, including a federal law called the Fair Credit Billing Act. To help you get all the consumer protection you can get, DEBTcheck.net is collecting information about whether or not you used a credit card in your situation. Debtcheck.net is NOT asking for your credit card number, we don’t want it, and we are NOT charging you for anything! We only want to know whether you used a credit card to help you get all the consumer protection you can get. Method of Payment on Transaction Payment method CashCheckCredit CardMoney OrderPayPalWire Transfer Please ensure that any photos or videos that you are uploading do not contain any of the generally prohibited items outlined in Section 2 of the Terms of Service. Photo of Person or Business This will be the main photo for this report that will be seen in search results. Image file Upload Documents, Images and Videos Provide us with as much proof of this debt as possible. Examples include but are not limited to; Contracts, Receipts, Videos, Voice Recordings, Screenshots of Communication via email/text, and Photos. Be sure to remove any personal information that you do not want people to see. NOTICE: Do not post an image or video that was created by someone other than you unless you have permission from the photographer or creator to post it. Please refer to our Terms of Use regarding violation of the intellectual property rights of others. If you have any trouble at all uploading your photos, please email us for support and include your photos with a caption for each photo you include. Send your email to support@debtcheck.net Upload documents File Upload your multiple files here 1 File Name: File Size: Add file Upload images Image Upload your multiple files here 1 Add image Video File Upload video Your videos 1 File Name: File Size: Add video Youtube link Youtube Videos Video link 1 Add youtube link Validate Email You are not authorized to view the contents of this page. Please log in to view the submissions