Date

Bill Collector Name and Address

RE: [Name of Creditor] Account No. [ ]

Dear Sir or Madam:

I am writing to request that you stop all contact with me regarding the above account as required by the Fair Debt Collection Practices Act, 15 USC sec. 1692c(c).

I am unable to pay the debt at this time.

Sincerely,

Your Signature

[Your Name and Address]