Submit a Document

Send us a Document

We want to make it as easy as possible for you to get the service you need to resolve your account. Use the form below to send us a document.

If you are disputing your debt please go to Dispute My Account.

1. General Account Information
Please include Diversified's eight-digit account number located on your statement.
Account number*
Creditor
First Name*
Last Name*
Address*
City*
State*
Zip*
Best Way to Contact*
2. Telephone Disclaimer
Phone
Type of Phone
Telephone Disclaimer*
By checking this box, you are confirming that you are the named individual on this account and are authorized to review and discuss any personal information contained in the account. You further authorize Diversified Adjustment Service representatives to contact you at the numbers you have provided by telephone to discuss the account, including but not limited to contact via prerecorded messages and calls made by an automated telephone dialing system. You agree and confirm that the telephone number you provide belongs to you.
- I Acknowledge and Agree
3. Email Disclaimer
Email
Email Disclaimer*
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.
- I Acknowledge and Agree
4. Comments / Document Attachments
Comments
Attach File
Drop files here or
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