Debt Restructuring Intake Form

Note: The following items are required before we can begin working on your case.

If you're missing anything, our team will follow up to assist but submitting everything up front helps prevent delays and allows us to move forward faster.

A list of full account numbers and total balances
A signed & notarized Limited Power of Attorney

Note: If you don't know your full account numbers, we will need a copy of your TransUnion and Equifax Credit Reports to obtain them on your behalf.

⚠️ The Power of Attorney must be notarized before uploading ⚠️

How to Download TransUnion and Equifax Reports from AnnualCreditReport.com

To download free credit reports from TransUnion and Equifax, visit AnnualCreditReport.com. You'll need to verify your identity through a process that includes your Social Security Number. Once verified, you can request and access your reports from the three major credit bureaus: Equifax, Experian, and TransUnion. Here's how to download your reports:
1. Go to AnnualCreditReport.com: This is the official website where you can request your free annual credit reports.
2. Verify Your Identity: You will need to provide personal information to verify your identity.
3. Request Your Reports: Choose to request reports from all three bureaus (Equifax, Experian, and TransUnion).
4. Access and Download: Once your request is processed, you can access and download your reports. For TransUnion, you might need to print the report or save it as a PDF. For Equifax, you may find a download button on the report page.
5. Save or Print: After accessing your report, save it as a PDF or print it for your records.

How much does this cost?

Once negotiation nears the end, contact will be made to finalize the settlement and coordinate payment with you on the settlement. We cannot state enough the importance of maintaining the settlement per the terms of the agreement. If you accept the terms and conditions of the settlement and fail to maintain the settlement, there may be an additional fee to renegotiate the settlement.

There is a fee of 20-25% of what you save with a minimum of $175.00. Payment is due not later than five days after the agreement is finalized with the company that settlement is reached for the creditor/collector that is owed. There may be additional charges for resolving medical or utility collections of no more than $250.00.

Once the payment for our services has been processed, we will send you a copy of the written settlement agreement containing instructions on how to pay the settlement agreement.

Download the LPOA

Virtual Notary

Annual Credit Report

First Name *

Last Name *

Email *

Phone *

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Do you know the total balances and full account numbers for those accounts?

Please list as much as you can including creditor name,full account number (if known), and balance.

What’s the current status of the debt situation?

Additional Documents or Letters from Creditors

If you don't know your full account numbers, we can grab them on your behalf from your TransUnion and Equifax reports.
Please visit annualcreditreport.com to obtain a free copy of both TransUnion and Equifax. Please note, failure to provide full account or this will keep your case on hold.

Do you have a PDF copy of your most recent TransUnion and Equifax Reports? *

If yes, please provide a copy of your annual credit report:

Both TransUnion and Equifax

Would you like us to include all of the accounts from your credit report in this program?

Do you already have a signed and notarized Limited Power of Attorney? *

Please provide the Notarized Power of Attorney:

⚠️ Please Note: A notarized Power of Attorney is required before we can begin working on your case ⚠️
Without it, we are legally unable to proceed.

We’ll send you reminders via text to help you complete this step, but please note:

Your case will remain on hold until the Notarized LPOA is submitted.

Next Steps:
Download the LPOA
Schedule Online Notarization

To negotiate the best possible deals with your creditors, we need to understand what kind of payment strategy fits your situation. In general:

The more we can offer upfront as a lump sum, the better discounts we can secure.
If a lump sum isn’t available, a strong monthly payment plan still allows us to create favorable settlements over time.

Please answer the next few questions as accurately as possible so we can build the right strategy for your case.

How much cash do you have available right now to use toward settling your debts?

Note: The more we can offer upfront as a lump sum, the better deal we can negotiate on your behalf.

If your lump sum isn't enough, how much can you realistically afford to pay monthly toward your debt?

Note: The more you can contribute, the better deals we can get.