GLA Collection Company, Inc. - Customer ID Verification Form

Customer Identification Verification and 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.

Thank you,
G. L. A. COLLECTION COMPANY, INC
DEPT #002
PO BOX 7728
LOUISVILLE, KY 40257
PHONE: 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.