Credit Management & Debt Consolidation Services All on-line applications are secure and strictly confidential. Any information submitted by you will not be made available to any outside party. Personal Information  Name:  Address:  City:  State / Zip: Alabama Alaska Arizona Arkansas California Colorado Connecticut D.Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming  E-mail:  Home Phone:  Work Phone:  Extension:  Monthly Income:  Total Debt Amount: Under $ 2,500 Under $ 5,000 Under $ 7,500 Under $ 10,000 Under $ 15,000 Under $ 20,000 Under $ 30,000 Under $ 40,000 Under $ 50,000 Over $ 50,000 Contact Information Best way to contact you?   Home Phone Work Phone Best hours to contact you? 9 am - Noon Noon - 5 pm 6 pm - 9 pm 9 pm - 11 pm Your reason for counseling?   Lowered Interest Rates Reduced Payment Combined Monthly Payment Credit Clean-Up Other Which start date would be the best for you? 7th 15th 21st 30th  How did you hear about us? Altavista AOL Billboard Dmoz Excite FindWhat Go.Com Google GoTo.Com Inktomi Kanoodle LookSmart Lycos MSN NBCI Newspaper Netscape Other Radio Search.Com Television Wherewithal.Com Yahoo Zeal  If other, please specify: [ Our Company | The Program | Questions | Credit Laws | Credit Reports ] [ Credit Network | Apply Today | Español | Contact Us | E-Mail Us ] Site Map All Rights Reserved. ® 2001 Copyright © 2001 Credit Techs Debt Consolidation Services, Inc.