Credit Counseling Application

Debt Consolidation can help lower your monthly payments by reducing and at times eliminating your high interest ratesand eliminate late fees! This is not a loan, there is no obligation to you. Once you fill out one of our debt free applications, a professional debt management specialist will contact you within 48 hours to discuss our debt consolidation program. Once approved you will be able to enjoy monthly savings at times of up to 50-60% or sometimes even more!!!!


Benefits of our Credit Counseling program: Cut Payments up to 70% ~ Make One Low Monthly Payment ~ Fast one hour approval ~ Elimination of past-due collection calls ~ Account re-aging *Note: Use the tab key to go between fields and press enter once when ready to submit. BOLD FIELDS REQUIRED and at least ONE CREDITOR

Name

Street Address

City     State    Zip

Home Phone

Work Phone        

Email

Net Income

Total Debt Amt

Best Time To Call

Please fill in your creditor information below:

Creditor Name

Total Owed

Month Paymt

Type of Debt

Months Behind
If you have more than 5 creditors we will take the additional information when we contact you.

Debt-Consolidation-Kimberly.org Educational Material • Debt Links • FREE APPLICATION