Model Validation Notice

North South Group
P.O. Box 123456
Pasadena, CA 91111-2222
(800) 123-4567 from 8am to 8pm EST, Monday to Saturday
www.example.com

To:

P
 erson A
2323 Park Street
Apartment 342
Bethesda, MD 20815

Reference: 584-345

North South Group is a debt collector. We are trying to collect a debt that you owe to Bank of
Rockville. We will use any information you give us to help collect the debt.
Our information shows:

How can you dispute the debt?

You had a Main Street Department Store credit card from Bank
of Rockville with account number 123-456-789.

§ Call or write to us by August 28, 2020, to dispute all or part
of the debt. If you do not, we will assume that our information
is correct.

As of January 2, 2017, you owed:

$ 2,234.56

You were charged this amount in interest:

+

$ 75.00

You were charged this amount in fees:

+

$ 25.00

You paid or were credited this amount
toward the debt:

–

$ 50.00

§ If you write to us by August 28, 2020, we must stop
collection on any amount you dispute until we send you
information that shows you owe the debt. You may use
the form below or write to us without the form. You may
also include supporting documents. We accept disputes
electronically at www.example.com/dispute.

$ 2,284.56

What else can you do?

Between January 2, 2017 and today:

Total amount of the debt now:

§ Write to ask for the name and address of the original
creditor, if different from the current creditor. If you write
by August 28, 2020, we must stop collection until we send you
that information. You may use the form below or write to us
without the form. We accept such requests electronically
at www.example.com/request.
§ Go to www.cfpb.gov/debt-collection to learn more about
your rights under federal law. For instance, you have the
right to stop or limit how we contact you.
§ Contact us about your payment options.
Notice: See reverse side for important information.

§ Póngase en contacto con nosotros para solicitar una copia de
este formulario en español.

How do you want to respond?
Mail this form to:
North South Group
P.O. Box 123456
Pasadena, CA 91111-2222

Check all that apply:
o I want to dispute the debt because I think:
o This is not my debt.
o The amount is wrong.
o Other (please describe on reverse or
attach additional information).
o I want you to send me the name and
address of the original creditor.

Person A
2323 Park Street
Apartment 342
Bethesda, MD 20815

o I enclosed this amount:

$

Make your check payable to North South
Group. Include the reference number 584-345.
o Quiero este formulario en español.