Co-Operative Adjustment Bureau, Inc.

Your Friendly Collection Agency!

Phone: (925) 305-2667
Fax: (925) 305-2676

360 Civic Dr., Suite B
Pleasant Hill, CA 94523


Contact Form & Consent for Electronic Communication (E-Mail)
Unencrypted email is not a secure form of communication. There is some risk that identifiable information and other sensitive or confidential information that may be contained in an email may be misdirected, disclosed to or intercepted by, unauthorized third parties. Your information will NOT be sold or transmitted to any parties outside of Co-Operative Adjustment Bureau, Inc. or possibly it's assigning client (if contacting us about a specific matter).

You may consent to receive email from us, authorizing our office to send e-mail to the address you provide. You may withdraw your consent at any time by providing our office notice in writing by using this form, emailing our office, or mailing our office written notice withdrawing your consent.

If you choose not to consent, or to withdraw consent of electronic communications, we will contact you at the telephone number provided, unless specifically directed not to call in the message area of this form. The IP Address of the individual submitting this form will be attached to the consent or withdrawal of consent.
Please fill in the form below to contact us and to authorize or withdraw authorization of electronic communications (e-mail).
Fields with * are required to fill in.
Name: *
Company:
Email: *
Phone: *
Account Number (if known):
City:
Subject:
Message:
I consent to the above:
I HAVE READ THE ABOVE NOTICE & CONSENT
TO ELECTRONIC COMMUNICATION.

OR

I DO NOT CONSENT:
I HAVE READ THE ABOVE NOTICE & DO NOT CONSENT,
OR WITHDRAW CONSENT, TO ELECTRONIC
COMMUNICATION.