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Are you behind on payments?

Please select an option below

Yes

No

Have you experienced any of the following?

Please select one or more options below that apply to you

Late Payment Charges

Threatening Letters

Bailiff / Court Action

Increaed Stress

What is the total value of your debt?

Please select an option below

Less than £5,000

£5,000 to £20,000

More than £20,000

Select your employment status

Choose an option below that applies to you

Full-time

Self Employed

Part-time

Unemployed

We just need a few details

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Are you behind on payments?

Please select an option

Yes No

Have you experienced any of the following?

Please select one or more options below that apply to you

Late Payments

Threatening Letters

Bailiff / Court Action

Increased Stress

What is the total value of your debt?

Choose an option below that applies to you

Below £5,000 £5,000 to £10,000 £10,000 or above

Select your employment status

Choose an option below that applies to you

Full-time employed Part-time employed Self employed Unemployed

We just need a few more details

Your name

Your email address

Your phone number

Best time to call you

Morning Lunch time Afternoon Tea time Night

What region do you live in?

England Scotland Wales Northern Ireland

By submitting the form you give permission for The Debt Crisis to use your information to contact you in relation to these services and to provide you with updates only

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