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Settlement Offer Form

THIS COMMUNICATION IS WITH A DEBT COLLECTOR AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. If the phone number you provided is routed to a mobile or cellular device, you are authorizing a representative of Couch, Conville & Blitt LLC to contact on such device.

*By submitting this offer, you are Authorizing us to contact you. You understand that the offer you submitted is not accepted and binding until you have been notified of its acceptance in writing by our firm.