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Getting Help for Your Debt Problems

Below is a short form. If you live in the Province of Ontario and owe more than $10,000 in unsecured debt, we may help you.

Completing this form gives Credit Support Services. permission to contact you. It also indicates to us you are ready to start dealing with the problem.

Completing the form does NOT create a binding contract for either YOU or Credit Support Services. You are in control of your choices.

All information you provide is kept completely confidential. We never share it or your email address with any outside source.

The information you provide by completing this form is only preliminary. We use a more extensive form which needs to be completed before we can do a full analysis of your situation and suggest the options you have available.

If you are near one of our offices, we can arrange an appointment for you. If you are in the province but further away, we can send you the more extensive forms to complete and return. The forms can be provided in MS Word or PDF format.

NOTE: At the moment we only serve Ontario residents.

Bill Lutton, CEO, Credit Support Services, Ontario, Canada

* -- required field

* Your Name:

* Your Email:                    

* Confirm Email:

* City/Town:
  Province: ONTARIO only

* Phone Number: (include area code)
-

Best Time to Call:

How did you find us?:

(Total Debt is all unsecured debt. Don't include Mortgages, property taxes, co-signed loans or secured loans. Enter the amounts for those items in tthe space provided.)

Car Loan(s) (balance owed): $
Mortgage(s) (balance owed): $
Property Taxes (balance owed): $
Co-Signed Debt(s) (balance owed): $

Estimated Total Debt: $
Includes: (check what applies)
Bank Loan(s)                    Student Loan(s)
Credit Cards                     Bank Overdraft(s)
Line of Credit                    Income Taxes
Friend or Relative Loan      Business Debt
Pay Advances                    GST or PST
Other

Form will be sent in Adobe (.pdf) and can be filled in. You'll need Adobe Reader to open and complete the form.

Other Comments:

Check your entries for accuracy and then hit "submit" to send the form.
    

All information you provide is kept completely confidential. We never share it or your email address with any outside source

 


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