Free Debt Relief Evaluation

Name:*
Phone:*
-
E-mail:*
Do you currently live in West Virginia?*
Have you lived in WV for at least 6 months?*
Are you over 18?*
Marital Status:*
How many people live in your home?*
Have you filed bankruptcy in the past 8 years?*
Total family income:*
Home:
Home value:
Amount owed on house:
Car/Cars:
Car value/values:
Amount owed on car/cars:
Do you own a business?
If so, briefly describe what type:
Do you owe Doctor or Hospital bills?
Do you owe credit cards?
Have you had a vehicle repossessed?
Do you have judgements/ levies filed against you?
Are your wages being garnished?
Do you need a fresh start in life?
Preferred contact method:

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