Submit Bankruptcy Information

Thank you for visiting our site. Please complete as much of the information below as possible to ensure CACi is able to locate, confirm, and remove from active collections any account(s) that have been included in your bankruptcy.

Please understand that submission of this form is for those who have retained an attorney and filed bankruptcy. If you have not yet filed bankruptcy and are considering your options, please consider calling one of our professional Account Resolution Specialists who may be able to assist you in establishing a repayment plan that could work within your budget.

Your Personal Information

Your Reference Number

Your Name *

Your e-mail *

Your Address

Address Line 1

City

State

Zip Code

Best Phone Number to reach you

Alternate Phone Number to reach you

Your Date of Birth *

Last four digits of your SSN

Your Bankruptcy Case Information

What Chapter did you file? *

What is your Case Number? *

Discharged, Dismissed, or Pending? *

Discharge Date

Your Bankruptcy Attorney's Contact Information

Attorney's Name *

Attorney's e-mail

Attorney's Phone Number

Attorney's City and State *

Other Information that you would like to include

Upload Document(s)

Click or drag a file to this area to upload.