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Credit Card Debt $ Select One 0 1 - 2,499 2,500 - 4,999 5,000 - 7,499 7,500 - 9,999 10,000 - 12,499 12,500 - 14,999 15,000 - 19,999 20,000 - 29,999 30,000 - 39,999 40,000 - 49,999 50000+ Other Unsecured Debt $ Select One 0 1 - 2,499 2,500 - 4,999 5,000 - 7,499 7,500 - 9,999 10,000 - 12,499 12,500 - 14,999 15,000 - 19,999 20,000 - 29,999 30,000 - 39,999 40,000 - 49,999 50000+ Number of Creditors Select One 2 3 4+ Status of Bill Payments Select One Up to Date About to Fall Behind 1 Month Behind 2 or More Months Behind I want to Select One Eliminate My Debt Consolidate My Debt Seek Advice Own a Home? Yes No

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