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First Name

Last Name

Phone

Street Address

City

State

Postal / Zip code

Age

Occupation

Ages of children living at home

Approximate Annual Household Income

What are your BIGGEST Financial Concerns?

Managing my debt to improve my financial and mental health

Building my nest egg in a safe environmnet for short/medium term goals

Creating a retirement income I can count on

Having access to my money

Paying college expenses

Recapturing interest and fees from financial institutions

OTHER

Other concerns

Select all loan/debt types you have outstanding balances on.

Mortgage

Credit Card

Auto Loans

Other Debts/Loans

MORTGAGE(S): Total Balance?

CREDIT CARDS: Total Balance?

MTG: How much do you pay extra?

CC: How much do you pay extra?

AUTO LOANS: Total Balance?

OTHER LOANS/DEBTS: Total Balance?

AUTO: How much do you pay extra?

OTHER: How much do you pay extra?

How did you hear about Debt free in 3?

Were you referred by someone?

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Your Debt FREE in 3 Specialist will contact you soon to schedule your Free Consultation and Analysis! Check your email for instructions regarding the information you will want to have handy for this appointment. We're excited to help you on your path to be Debt Free in 3!