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Credit Counseling Services


Fax/Mail Application

Please complete the following application first; print it and then fax or mail it to our processing department. One of our credit counseling professionals will contact you within 24 business hours to review your information. Please note: Your privacy is very important to us. We do not share your personal information with anyone not directly involved in the processing of your application.

Fax: 239-437-5591

National Association of Credit Counseling

MyCreditCounselor.org
6710 Winkler Rd

Suite 2

Fort Myers, FL  33919

    

 My Information
 Name:

 Telephone: - Best time:
 Fax Number: -
 Address:
 City State Zip , ,
 Soc. Sec. #: (We do not accept residents of CT, NY & OR)
 Financial Information (DO NOT include home or auto loans)
 My Credit is:
   Example

Balance $:
   1. Creditor

Balance $:
   2. Creditor

Balance $:
   3. Creditor

Balance $:
   4. Creditor

Balance $:
   5. Creditor

Balance $:
   6. Creditor 

Balance $:
   7. Creditor

Balance $:
   8. Creditor

Balance $:
   9. Creditor

Balance $:
 10. Creditor

Balance $:
I have more creditors (More creditors may be added later before you sign up)
 Avg.# of Mos. Past Due (How many months is the average account past due?)

Tired of writing checks? We now accept automatic payments from checking accounts. Ask one of our credit counselors how to get started.

 
 
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