Bad Debt Help

The Jackpot Funding Company

Buy My Delinquent Judgment
*=Required Field

SECTION A - Judgment Information
*Case #:
*Judgment Amount:
*Judgment Date:	,
*Court Name:
*Court Address:
*Court County/City:		*Court State:
*Court Zip:		*Court Phone:

SECTION B - Debtor 1 Information
If debtor filed bankruptcy, is judgment included in bankruptcy?
*Name:
*Address:
*City:		*State:
*Zip:		SSN:
*Phone:		*Fax:
Debtor 2, IF ANY, Information
If debtor filed bankruptcy, is judgment included in bankruptcy?
Name:
Address:
City:		State:
Zip:		SSN:
Phone:		Fax:
Debtor 3, IF ANY, Information
If debtor filed bankruptcy, is judgment included in bankruptcy?
Name:
Address:
City:		State:
Zip:		SSN:
Phone:		Fax:

SECTION C - Creditor 1 (Your) Information
I am:
*Name:
*EMail:		*SSN/Tax ID:
*Address:
*City:		*State:
*Zip:
*Phone:		Fax:
Creditor 2, IF ANY, information
I am:
Name:
EMail:		SSN/Tax ID:
Address:
City:		State:
Zip:
Phone:		Fax:
Creditor 3, IF ANY, information
I am:
Name:
EMail:		SSN/Tax ID:
Address:
City:		State:
Zip:
Phone:		Fax:

SECTION D - Required
*Briefly describe the judgment and why it is delinquent:
*Does the debtor own property?
*Is debtor's property on judgment different from records at tax assessor's office? (property owned by a trust cannot be touched as an asset)
Data entry is complete. Be prepared to mail-in copies of the following when we contact you: - The Judgment




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