Community Credit Counselling Services Contact Information Form

Knowing and understanding that credit problems are one of the leading causes of stress; our credit counselors are carefully selected with patience as an important credential. Whether it is counseling you through credit issues or helping you consolidate your bills, each and every counselor can help.

*Please fill out all fields so that we may help you better when our counselor contacts you.*

 
* First Name:
* Last Name:
* Day Phone:
Include Area Code
Night Phone :
* Email:
*City
  
* Province:

Your Credit History

* What is the total amount of your unsecured debts? Credit Cards and Unsecured Loans
What is your current credit rating?
Do you have a Student loan in Default
* What is the best time to reach you?
* Do you own or rent your home? Own Rent
* Is your mortgage current or past due? Current Past Due N/A
* If past due, for how long? 1 month 2 months
3+ Months N/A
* Are you currently receiving collection calls from a collection agency? Yes No

 
* Briefly describe your reasons for applying to our Debt Management Program.

If you are applying because of a student loan debt please specify Type and amount. How long Past Due.

Please Fill Out - Click below in any box that applies to your debt:

* Credit cards
* Personal Loans
* Past due utility bills

* Medical bills
Other

 
Any past due accounts? Yes No
If Yes, how many months past due?
How did you hear of us?

Please only click the submit button once.