What is your name? *

First Name

Last Name

How much debt do you have? *

Under $10,000

$10,000-$15,000

$15,000-$20,000

$25,000+

Are you currently being garnished? *

Yes

No

Which one of our offices is most convenient for you? *

Royal Oak

Flint

Sterling Heights

Have you ever filed for bankruptcy? *

Yes

No

Do you own a home?

Yes

No

What is your monthly income? *

Under $1,500

$1,500-$3,000

$3,000-$4,000

$4,000+