Creditor Name   
First Address Line 
Second Address Line  (if needed)
Third Address Line  (if needed)
City
State
Zip
Acct. No. (last 4 digits only) 
Started what year
Amount owed.  Whole dollars, no cents,  no periods, no dollar signs, no commas.  Example: if you owe $7,146.39, write 7146.    
What for
Your three initials (use your same initials for every creditor)
Look up address