Complaint / Leave a Note Form

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Form Distribution*
- Debtor
- Client
Kinum is a collection agency attempting to collect a debt. Any information will be used for that purpose. This communication is from a debt collector.
Name*
First Last
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Account Number
Nature of visit*
- Complaint
- Leave a Note
Details*
I authorize Kinum to respond to and communicate with me electronically by email in regards to my account.*
- Yes
- No
Email Address
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Name
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