Request A Receipt | Consumer Debt Collection Tools | Diversified Adjustment Service, Inc.

Request Itemized Statement

Please complete the form below to request an itemized statement by email regarding your account. By submitting the form you are confirming that you are the account holder and all information is accurate and valid. Please note that it may take up to 30 days to receive your request.

To ensure that the email we send you ends up in your inbox, and isn’t mistakenly sent to the junk folder, please whitelist our email address, which is rep@diversifiedadjustment.com

The email you receive with your information will be unencrypted and may not be fully secure. By completing this form you are requesting that the information be sent to you in this manner rather than by postal mail.

1. General Account Information
Please include Diversified's eight-digit account number on your statement.
Account Number*
Creditor*
First Name*
Last Name*
Address*
City*
State*
Zip*
2. Phone and Email Disclaimer
Phone*
Email*
Enter Email Confirm Email
Email Disclaimer*
You agree that Diversified Adjustment Service, Inc. may from time to time make calls and/or send text messages to you at any telephone number associated with your account, including wireless telephone numbers that could result in charges to you. You hereby confirm that any number you provide belongs to you. The manner in which these calls or text messages are made to you may include, but is not limited to, the use of prerecorded/artificial voice messages and/or automatic telephone dialing system. You further agree that Diversified Adjustment Service, Inc. may send e-mails to you at any e-mail address you provide us or use other electronic means of communication to the extent permitted by law. You agree and acknowledge that any e-mail address or any other electronic address that you provide is your private address and is not accessible to unauthorized third parties. You agree and acknowledge that you have requested that we send the document(s) you have requested to you at the e-mail address you have provided. Consent may be revoked at any time and by any reasonable means.
- I Acknowledge and Agree
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IMPORTANT

Request Itemized Statement

Request Itemized Statement

1. General Account Information

2. Phone and Email Disclaimer

Contact Diversified for a secure solution to your collection needs.