Credit Card Debt Consolidation
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   Fill out the form below to receive information on how to consolidate
   your credit card debt.

   (Currently we are only able to assist individuals with a minimum of
   $5,000 credit card debt. We apologize for this inconvenience.)

                           Consolidating your debt
                         (All fields are required.)
   First name
   ____________________ Address
   ____________________
   Last name
   ____________________ City
   ____________________
   Work phone
   ____________________ State
   [AK]
   Home phone
   ____________________ Zip/postal code
   ____________________
   E-mail
   ____________________ Country
   United States only__

                           Consolidating your debt

                           Total credit card debt
                           [Select one__________]

   Please call me at
   [Work______]

   Best time to call
   [Select one]
   Currently delinquent
   (*) Yes ( ) No Months behind
   [Select one______]

                                Submit Reset

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