Consumer Account Dispute Form

Please complete the following Account Dispute Form to dispute a debt electronically. You may also call CBusa directly at 877-485-7940 and an agent would be happy to assist you. This is an attempt to collect a debt by a debt collector and any information obtained will be used for that purpose.

* Denotes required fields

Consumer Details

Consumer *

Address *

Email Address *

Phone Number * (allowed format : 000-000-0000)

Reference Number *

Dispute Details

Dispute Reason *


Attachments (allowed formats : pdf, jpg, jpeg, png)

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Signature *

By sending this form you agree that we may contact you by email, phone and/or text message in response to your inquiry or to resolve your account after validation or the name and address of the original creditor have been provided to you as outlined in your letter. Providing your email and/or phone number and corresponding consent to be contacted through those channels is not required in order for to exercise your rights outlined in the letter and does not alter any required obligation of us to cease further communications on your account. For your privacy and protection, please provide us with your personal email address, as work, school or governmental email addresses may be monitored by third parties. You should also be aware that if you provide us with an email of a shared account, third parties may also be able to access your personal information. You may opt out at any time.