Debt Melt-Down Application

CONGRATULATIONS!!!

You have decided to take the first step toward Financial Freedom!!!

Please gather all information needed to fill out this form completely...You will need all your current liability statements that you pay monthly. (Cars, Credit Cards, Mortgages....Etc.)

The More information you provide the More accurate our numbers will be for you!!!

ALL INFORMATION OBTAINED IS STRICTLY CONFIDENTIAL AND
WILL NOT BE USED BY ANYONE OUTSIDE OF HAYS CONSULTING,
LLC.

FREE Debt Melt-Down Analysis Application Form

For us to give you the best service possible we will need all the
information ACCURATELY filled in below. The (TAB Key) moves you
from one line to another. All (*) fields are required. If the line doesn't
apply to you please put (N/A). If you have any questions
while filling out the application please call us @ (816) 795-7878.

YOU WILL NEED ALL YOUR CURRENT LIABILITY STATEMENTS THAT
YOU PAY MONTHLY. (CARS, CREDIT CARDS, MORTGAGES....ETC.)
IT IS ALSO VERY IMPORTANT THAT YOU PUT THE INTEREST RATES
ON ALL ACCOUNTS SO WE CAN GIVE YOU THE MOST ACCURATE
NUMBERS POSSIBLE.

AT THE END OF THE APPLICATION PLEASE
HIT SUBMIT AND YOUR INFORMATION WILL BE FORWARDED TO
US AND SOMEONE WILL GET BACK IN TOUCH WITH YOU AS SOON
AS POSSIBLE.

THERE IS NO COST OR OBLIGATION FOR THIS FREE ANALYSIS. WE
ONLY MAKE MONEY IF WE ARE ABLE TO HELP YOU SAVE MONEY!

THANKS AGAIN AND CONGRATULATIONS ON TAKING YOUR FIRST
STEP TOWARDS "FINANCIAL FREEDOM."

Title of this group of fields

*Name:
*Email:
*Phone:
*Date of Birth:
*Social Security #:
*Address:
*City:
*State:
*Zip Code:
*Yrs. There:
*Best Contact Number:
*Call you at work Y/N:
Work Number:
*Gross Monthly Income:
Other Gross Monthly Income:
*Card #1 Name,Rate,Payment,Payment you make,Balance:
*Card #2 Name,Rate,Payment,Payment you make,Balance:
*Card #3 Name,Rate,Payment,Payment you make,Balance:
*Card #4 Name,Rate,Payment,Payment you make,Balance:
*Card #5 Name,Rate,Payment,Payment you make,Balance:
*Card #6 Name,Rate,Payment,Payment you make,Balance:
*Card #7 Name,Rate,Payment,Payment you make,Balance:
*Card #8 Name,Rate,Payment,Payment you make,Balance:
*Card #9 Name,Rate,Payment,Payment you make,Balance:
*Card#10 Name,Rate,Payment,Payment you make,Balance:
*Student Loan #1 Name,Rate,Payment,Balance:
*Student Loan #2 Name,Rate,Payment,Balance:
*Auto Loan #1 Name,Rate,Payment,Balance:
*Auto Loan #2 Name,Rate,Payment,Balance:
*Auto Loan #3 Name,Rate,Payment,Balance:
*401k Loan Name,Rate,Payment,Balance:
*Personal Loan #1 Name,Rate,Payment,Balance:
*Personal Loan #2 Name,Rate,Payment,Balance:
*Home Loan/1st Mortgage Name,Rate,Payment,Balance:
*Are taxes and Insurance Included with Payment Y/N:
*Taxes per month:
*Insurance per month:
*Equity Loan/2nd Mortgage Name,Rate,Payment,Balance:
*Current Home Value:
*Spouse's Full Name (If applicable):
*Spouse's Date of Birth:
*Spouse's Social Security #:
*Spouse's Gross Monthly Income:
Best Contact Number:
*I/We authorize for a credit check Y/N :
Comments and Questions:

Note: Fields with an * are required