Preliminary Application

This preliminary application is used to provide our counselors with some basic information about your current financial situation. This application does not obligate you to participate in our program, nor does it guarantee your enrollment in our program.

You can also call us toll-free at 1-888-369-DEBT if you would prefer to speak with someone directly.
Please mention the code: CDR-1

Items in red are required. General Information           First Name:   Last Name:   City:   State:   Choose One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:   Email:   Best time to contact you:   Choose One Morning at work Morning at home Afternoon at work Afternoon at home Evening at work Evening at home Home Phone:   Work Phone:         Financial Information           Total Unsecured Debt:   Choose One $ 7,500 - $10,000 $10,000 - $15,000 $15,000 - $20,000 $20,000 - $30,000 $30,000 - $40,000 $40,000 - $50,000 $50,000 - $60,000 $60,000 - $75,000 $75,000 - $100,000 Over $100,000     (Must be greater than $7,500) Total Gross Monthly Income:   Comments/Questions: