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RayEthell
2021-02-08T11:43:03+11:00
Regain Control of Your Finances
After completing this confidential obligation free enquiry form a consultant will contact you and work for you to find the best Solution to help you Regain Control of Your Finances.
Step 1 of 4 - Your Contact Details
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Name
*
First
Last
Email
*
Best number to call you on
*
Which Debt Solution are you requiring?
*
Debt Consolidation Loan
Debt Negotiation
Money Management Services
Please tick 1 or more boxes for an obligation free consultation.
What is your home address?
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
What are your living arrangements?
*
Own Home
Renting
Living with Family
Boarding
If own home what is the estimated value?
What is your main source of your income?
*
Employed (P.A.Y.G)
Self employed (Includes being a director of your own company)
Social Security (Includes all forms of social security)
Can you verify your income?
*
Yes
No
How is your credit history?
*
Excellent
have unpaid defaults less than $1,000
have unpaid defaults greater than $1,000
have paid defaults over the last year for less than $1,000
have paid defaults over the last year for more than $1,000
Shocking
If you have a mortgage are you behind with this Mortgage?
No
1-2 Months
3 Months
4 Months
5 Months
6 Months
6 Months+
List all creditors (Mortgages, Credit Cards, Loans, Leases, Telco, Utilities, Financial or Other).
Creditor
Type of Debt
Balance Owing
Monthly Repayments
Arrears?
YES
NO
Eg: Creditor: ANZ | Type of Debt: Credit Card | Balance Owing: $30,000 | Monthly Repayments: $780 | Arrears?: Yes Click on the +Plus icon to add each debt to a new row.
Any other comments / objectives / information that may help us
Upload Documents (optional)
Accepted file types: pdf, doc, docx, csv, txt, jpg.
Upload any documents that you think might help you to secure a loan including credit file . (doc, docx, csv, pdf, jpg and txt files accepted)
Phone
This field is for validation purposes and should be left unchanged.
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