V&J - Vargo & Janson, P.C.
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Refer an Account Online
Fill out the form below as completely as possible. Provide any additional information that may be useful in assisting us in collecting your account.
 
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Please note: fields marked with an asterisk (*) are required to process your submission. If you do not have information for one of these fields, type "N/A".
 
Your Information:
* Your Name:
Your Title:
* Company Name:
* Address 1:
Address 2:
* City:
* State:
* Zip Code:
* Phone Number:
Fax Number:
* E-mail Address:

Debtor Information:
* Name:
SSN:
Date of Birth:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
Last Known Employer:
Employer Phone:

Co-Debtor Information:
Name:
SSN:
Date of Birth:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
Last Known Employer:
Employer Phone:

Account Information:
Account Ref. #:
* Amount Due:
Interest Rate:
* Date of Last Payment:
* Last Service/Delinquent Date:
Type of Account:
(Check all that apply)
Credit Card
Medical
Education - Tuition
Education - Perkins
Education - DULF
Retail
Personal
NSF Check
Auto Loan
Commercial
Judgment
Purchased Debt
Other
Comments:
Do you have a digital copy
of the Proof of Debt?
Proof of Debt File:


.pdf, .doc or .xls file format only.


.pdf, .doc or .xls file format only.


.pdf, .doc or .xls file format only.

Contingency Fee Agreement & Disclosure Statement.
 
If you have not yet signed a Contingency Fee Agreement & Disclosure Statement, a Vargo & Janson representative will contact you.

 
Referring account. One moment, please.

This is an attempt to collect a debt by a debt collector. Any information obtained will be used for that purpose.