Customer ID Verification Form

GLA Collection Company, Inc.
Customer Identification Verification & Email Permission Form

Please type the information requested below for authorization and verification purposes.
By providing this information you also agree to allow GLA Collection Company to contact you via email at the email address listed above in the future.

Please complete and submit this form:

* Indicates required field

Your Full Name *

First

Last

Phone Number *

Email *

Spouse Name *

Current Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Last 4-digits of your Social Security Number (Only last 4 digits) *

Any previous Last Name (Maiden) *

Previous Address (if moved within the last 7 years) *

Line 1

Line 2

City

State

Zip Code

Country

Comments and/or Questions Details *

Submit

Thank you,
GLA COLLECTION COMPANY, INC
DEPT #002
PO BOX 7728
LOUISVILLE, KY 40257
PH 502-267-7522
FAX 502-267-1124
TOLL FREE 1-800-928-7809
TO PAY ONLINE VISIT: WWW.GLA-PAYMENTS.COM

*****IF YOU DO NOT WANT TO FILL OUT THE ABOVE INFORMATION PLEASE FEEL FREE TO CALL OUR OFFICE TOLL FREE AT 1-800-928-7809 AND ASK TO SPEAK WITH A REPRESENTATIVE WHO CAN ASSIST YOU. OUR OFFICE HOURS ARE MONDAY-FRIDAY, 8AM-5PM.

This communication is from a debt collector and is an attempt to collect a debt. Information obtained will be used for that purpose.

GLA Collection Company, Inc.​Customer Identification Verification & Email Permission Form

Please complete and submit this form:

GLA Collection Company, Inc.
Customer Identification Verification & Email Permission Form