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 *

First Name *

Middle Name

Last Name *

Address *

Street Address *

City *

State/Province *

Postal/Zip *

Country *

Email Address *

Personal email address for future written communication.

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

Best number to reach you by phone/ text message

Reference Number *

Creditors Bureau USA Reference # / Account # Located on the letter you received from CBusa

Dispute Details

Dispute Reason *

Dispute Reason

Description

Please describe in detail what you would like us to review on your account (Maximum 1000 words allowed). Please include information that will help us to discuss the account with your Creditor.

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

Browse Files

Drag & Drop Files Here

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.

By clicking submit, you are agreeing to the terms and conditions as stated above and attest that the information provided is true and accurate to the best of your knowledge.

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