Debtor Information

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Name

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Company

Address

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City

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State

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Phone:

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Email

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Employer Name

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Lump Sum Settlement Offer

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Terms and Conditions: This is an attempt to collect a debt. NAS Omaha is a debt collector and will use all supplied information towards that purpose. Your offer of settlement or proposal for payment is not effective until NAS Omaha contacts you with an acceptance. Failure to make payments on time in the agreed upon amount may result in NAS Omaha declaring the settlement or proposal withdrawn. In the event of a withdrawn settlement or proposal, the full remaining balance will be due. NAS Omaha has your permission to contact you by email regarding this debt. Checking the box on the left indicates your understanding and acceptance of these terms.