Debt/Tax Relief First name: Last name: Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code: Home Phone: - - Work Phone: - - E-Mail: Select an Amount $500 - $1,000 $1,000 - $5,000 $5,000 - $10,000 $10,000 - $20,000 $20,000 - $40,000 $40,000 - $60,000 $60,000 - $80,000 $80,000 - $100,000 Over $100,000 What is the total amount of your unsecured debts? Please list one of your current creditors. $ .00 Current balance Select an Option- Credit Card Dept. Store Credit Medical Bills Utility Bills Type of debt My combined STUDENT LOANS exceed $20,000 (optional) Please inform of other services in the future Notice: Undefined index: success in E:\Inetpub\mn.annexus.com\form_fin_debt.php on line 221