Online bankruptcy counseling at debthelper.com
Credit Card Management Services Inc.


Fields marked with * are mandatory!
   Contact Information
First Name   * ZIP   *
Middle Initial  Address   *
Last Name   * Apt # 
City   *
SSN    * State    *
Email  Phone   *
Cell  Fax 
   Personal Information
Gender  Date of Birth   *  (mm/dd/yyyy)
Language   * Reason for Debt   *
Marital Status   * Reason for Debt 
Race  Reason for Debt 
Living Condition   *    
   Spouse Information
First Name  SSN 
Middle Initial  Email 
Last Name  Date of Birth   (mm/dd/yyyy)
   Attorney/Paralegal Information
Firm Code    Bankruptcy Type 
Firm Name  Name 
Phone  Email 
Bankruptcy Case No    *

I. You are you:
 
Under penalty of perjury, I/We certify to the best of my/our knowledge that all of the information on this application is true, correct, and complete and made in good faith. I/We certify that I/We will personally complete the pre-filing bankruptcy counseling or pre-discharge bankruptcy educational course. I/We understand that knowingly making a false or fraudulent statement or misrepresentation about my/our identity or completion of the course work is a violation of the requirements of Federal law.
 
Debtor Information
First Name 
Last Name 
SSN 
Date of Birth 
General Information
Address 
City, State, ZIP  
 
II. Filing voluntary:
 
I/we are filing bankruptcy voluntarily and no one is forcing me/us to file against my/our will.
 
III. Not legal advice:
 
Although a counselor may answer general questions about bankruptcy, the agency does not provide legal or tax advice. If legal or tax advice is needed, you should seek the appropriate assistance from an attorney or tax professional.
 
IV. Legal Disclosure:
 
It is illegal for someone other than you to take Debthelper.com�s online Pre-petition Bankruptcy Counseling Session. DebtHelper.com will not issue a certificate if it is found that the person taking this online Pre-petition Bankruptcy Counseling Session is not you.
 
 


 
* Approved to issue certificates evidencing completion of credit counseling or a personal financial management instructional course in compliance with the Bankruptcy Code. Approval does not endorse or assure the quality of the Provider's services.

Copyright© 2010 Credit Card Management Services [ All Rights Reserved ]
1325 N Congress Ave. Suite 201, West Palm Beach, FL 33401
|| Phone: 561-472-8000 || Toll Free: 800-920-2262 || Fax: 561-844-0406 ||