mydebtsolution.com - Debt solutions. On Line. Anytime.

Wednesday, March 10, 2010

For a summary review of your debt needs and options, please complete and submit the information form below. All information is completely secure and confidential.

One of our Credit Consultants will contact you within 24 hours with a more detailed assessment and recommendations for you.

If you would prefer to be contacted by telephone, please indicate the best time and date to call.

Note: ** items are required fields to assure a prompt review and reply.

1	How did you find out about mydebtsolution.com?
2	Are your creditor payments up to date?	Yes No
3	Are you receiving collection calls?	Yes No
4	Total amount owing on all unsecured debts: (ie: credit cards, personal loans, lines of credit, overdrafts) Please do not include your mortgage, vehicle loans or household utility bills.
5	Total minimum monthly payments on the unsecured debts is: **
6	Your total monthly take home pay is: **
7	Your total monthly basic living expenses: (ie: mortgage/rent, utilities, groceries, auto loans, transportation, insurance, etc) ** Please do not include unsecured debt payments.
8	If you could consolidate your debts into one monthly payment, what do you feel you could reasonably afford?

	Your Contact Information

	Name: **
	City: **
	Province: **
	Postal Code:
	Email Address: **
	Telephone: **
	Preferred Contact Time/Date:

	Please tell us why you need help now:

If you wish to speak to a Credit Consultant directly we can be reached Toll Free in Canada 1.877.556.3500.