Debt Consolidation and Credit Repair

Full Name:
Please list all possible contact phone numbers.	Example: Home - xxx-xxx-xxxx Mobile - xxx-xxx-xxxx Office - xxx-xxx-xxxx
Email Address:
Did you complete the enrollment package?
Which program option works best for you?
Monthly payment due date starting on:
Creditor information:	Creditor Name Account Number Phone Number Creditor Name Account Number Phone Number Etc
Please tell us about the reasons you have fallen behind on these debts and why you are seeking assistance. This information will be compiled into a hardship letter for you.	Example: I have been quite ill for some time and have had to take leave of absence from my job due to my inability to stand on my feet for any length of time. I am battling Colon cancer and have had surgery in hopes of becoming cancer free. I went into cardiac arrest post surgery. I am presently experiencing severe kidney problems that may be stemming from my cancer and the treatment that I have been receiving. I have been notified by my present employer that they may not be able to hold my position any longer due to the length of time I have been away from work. I do live alone and depend solely upon myself for the care of my health and my personal business issues. I am enrolling in a debt settlement company to help me by consolidating all my bills to make sure you get paid, I am very sorry I had to do this but I am desperate for help and this is the best solution to get everything paid up. At the present time my medical bills are outrageous with no health insurance and these bills are taking priority so that I can continue with receiving the medical attention I so desperately need. I have tried to get on disability but they keep denying me telling me I’m not sick enough. I guess I have to be dead before they do anything about it. I would appreciate it greatly if you would work with me on this matter.
Do you have American Express accounts that you are enrolling?
Are there any other names on your debts? If so what is their full name, date of birth, and social security number?	test
Your Credit Specialist has emailed you the Limited Power of Attorney. We will need everyone listed on your debts to sign it. Please print, sign, and fax to: 1-866-739-5265. Have you received that email?
Do you have any questions that you would like to have addressed?	Type questions here.