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Knight, Mantzaris & Neal, LLP. The form collects debtor identity, debtor address, total amount owed and its itemized components, and the date the debt became due. It also supports optional certified-mail service with an enclosed payment, and requires affirmations that the debt is valid, prior formal demands were unsuccessful, supporting documents are attached, and no assignment, notice of bankruptcy, or dispute-preventing information exists.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/affidavit-collection-demand-letter-general-authorization-form/276637/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/affidavit-collection-demand-letter-general-authorization-form/276637.png","ImageObject",442,249,{"name":88,"@type":89},"Logic","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-30","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":20},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information must be provided to request the debt collection/demand letter?","Question",{"text":108,"@type":109},"Provide the debtor’s full name, the debtor’s business owner/representative (if applicable) and title, debtor address, total debt amount, and the date the debt became due. Also itemize how the total debt is made up, ensuring the figures precisely total the amount shown.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Is certified mail an option, and what is required?",{"text":113,"@type":109},"Yes. Check the applicable option to request certified mail to confirm receipt, include a check or money order for $8.00, and acknowledge that the letter will not be mailed until the certified-mail payment is received and processed.",{"name":115,"@type":106,"acceptedAnswer":116},"What declarations does the LegalShield member/authorized representative affirm?",{"text":117,"@type":109},"The member certifies the debt is valid and subject to collection, that formal written demands were previously made and unsuccessful, that supporting documents are enclosed, that the receivable has not been assigned or sold to a third party, that no bankruptcy notice has been received, and that information may be provided to the debtor if the debtor disputes.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},276637,1790030703,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":20,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":4},1099513958762,"https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1784791008015729253","GENERAL AUTHORIZATION FORM & LEGALSHEILD MEMBER AFFIDAVIT FOR REQUESTED COLLECTION / DEMAND LETTER(S)  \nTO: De Beaubien, Simmons. Knight, Mantzaris & Neal, LLP FAX \\#: 407-420-2092  \nPO Box 87, Orlando, FL 32802  \nFROM:   MEMBER ID:  \n(full name of LS member) INTAKE\\#:================================================================================== PLEASE PREPARE and mail a debt collection letter on my behalf to the following named individual or business (circle one), based upon the information provided below:  \n1) Full Name of Debtor:    \n2) (If debtor is a business) Full Name of the Debtor’s Owner or Representative, and applicable title (i.e., sole proprietor, president, treasurer, agent, associate):  \n___________________________________________________________________________  \n(Letter will not be set without the full name/title of owner or representative)  \n3) Debtor’s Address:   City/State/Zip:    \n4) Total Amount of Debt: $   \n5) The total amount of this debt as specified in \\#4 above is comprised of the following sums (i.e., principal, interest, costs, returned-check fees):  \n__________________________________________________________________________________  \n____________________________________________________________________  \n(All figures must precisely total the amount shown in \\# 4, above)  \n6) This debt was incurred and became due and owing as of the following date:  \n  .  \n7)   (Check if applicable) . I wish for this debt collection letter to be mailed via certified mail in order to confirm receipt. I have enclosed a check or money order in the amount of $8.00 for the cost of same and I understand that this debt collection letter will not be mailed until after payment for the certified mail has been received and processed.  \n(**NOTE: If your debt/claim is based on a writing of any kind (i.e., an agreement, contract, invoice, receipt, note, check, or other), then you must include also a complete legible copy of such writing(s). Include also a complete legible copy of any other documents that lend support to your claim, including any prior written demand(s). DO NOT SEND ORIGINALS.)  \nI , _____________________ (Name of Member or Business Authorized Representative)  \nHEREBY AFFIRM AND CERTIFY THE FOLLOWING:  \nThis debt is valid and subject to collection.  \nI have previously made formal demand(s) for payment of the debt upon the above-named debtor and that such demand(s) was/were unsuccessful; copy(ies) of any such written formal demand(s) is/are enclosed herewith.  \nI am providing with this affidavit a legible copy of any and all documents which support this debt and claim. This debt/account receivable has not been assigned or sold to any third party.  \nI have not received any written notice from the debtor or his/her/its attorney advising me or my business that said debtor has filed for bankruptcy protection.  \nI hereby acknowledge that all of the information provided herein may be provided to the debtor upon request if said debtor disputes this debt.  \nSignature of LegalShield Member or Authorized Representative Date","cbCaiooDqJkq1NVG","https://ap.wps.com/l/cbCaiooDqJkq1NVG","pdf",111752,"English","# Request Details\n## Debtor and Amount Information\n## Debt Due Date and Certified Mail Option\n## Member Affidavit and Signature","[{\"question\":\"What information must be provided to request the debt collection/demand letter?\",\"answer\":\"Provide the debtor’s full name, the debtor’s business owner/representative (if applicable) and title, debtor address, total debt amount, and the date the debt became due. Also itemize how the total debt is made up, ensuring the figures precisely total the amount shown.\"},{\"question\":\"Is certified mail an option, and what is required?\",\"answer\":\"Yes. Check the applicable option to request certified mail to confirm receipt, include a check or money order for $8.00, and acknowledge that the letter will not be mailed until the certified-mail payment is received and processed.\"},{\"question\":\"What declarations does the LegalShield member/authorized representative affirm?\",\"answer\":\"The member certifies the debt is valid and subject to collection, that formal written demands were previously made and unsuccessful, that supporting documents are enclosed, that the receivable has not been assigned or sold to a third party, that no bankruptcy notice has been received, and that information may be provided to the debtor if the debtor disputes.\"}]","Affidavit Collection Demand Letter - General Authorization Form | PDF",1789494519]