Debt Consolidation Portal Quote

Benefits of our Debt Management program: Non-for-Profit Org. Avoid bankruptcy-Reduced interest charges-Lower total monthly bill payments-No more late or over-limit fees-Higher percentage of principal paid each month-Enhance your credit history-End creditor harassment

Convenient, single monthly payment-Reduce your Debt up to 80%-Personal Information

All fields marked with an * are required

First Name:*	Last Name:*	E-mail:*
Address:*	City:*	State:*
		please choose AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code:*	Home Phone:*	Work Phone:

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Total amount of your Unsecured Debts:*

---Select an Amount--- $1,000 - $4,999 $5,000 - $10,000 $10,000 - $20,000 $20,000 - $30,000 $40,000 - $50,000 $60,000 - $70,000 $80,000 - $100,000 Over $100,000

What is the best time to reach you?:

--- Select a Time --- Before 9:00 am 9:00 am - 12:00 noon 12:00 noon - 3:00 pm 3:00 pm - 6:00 pm 6:00 pm - 8:00 pm After 8:00 pm Anytime

Tell us about your Debt Situation:

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Creditor*	Balance*	Monthly. Payment*	Creditor Type
			Credit Card Department Store Credit Utility - Disconnected only Personal Loan Furniture Loan/Credit Medical BillsCollections Medical Bills Non Collections --Select Creditor Type--
			Credit Card Department Store Credit Utility - Disconnected only Personal Loan Furniture Loan/Credit Medical BillsCollections Medical Bills Non Collections --Select Creditor Type--
			Credit Card Department Store Credit Utility - Disconnected only Personal Loan Furniture Loan/Credit Medical BillsCollections Medical Bills Non Collections --Select Creditor Type--
			Credit Card Department Store Credit Utility - Disconnected only Personal Loan Furniture Loan/Credit Medical BillsCollections Medical Bills Non Collections --Select Creditor Type--
			Credit Card Department Store Credit Utility - Disconnected only Personal Loan Furniture Loan/Credit Medical BillsCollections Medical Bills Non Collections --Select Creditor Type--

*PLEASE DO NOT INCLUDE MORTGAGES, IRS, CAR LOANS & STUDENT LOANS
Creditor examples: American Express-Associates National-ATT-Bank of America-Capitol One CHASE-CITIBANK-DISCOVER-First Bankcard-FIRSTUSA-FLEET-Household Credit-Hurley State Bank-MBNA-Target (Retailers National Bank)-WACHOVIA-WELLS-FARGO

(Please click only once to avoid multiple submissions)