Debtmerica Relief - Debt Settlement Company

WFG Rep. Name	WFG Rep. Code #
WFG Rep. Phone # ( ) -	WFG Rep. Email
WFG Mktg. Dir. Name	WFG Mktg Dir. Email

Client First Name	Client Last Name
Spouse First Name	Spouse Last Name
Client Phone ( ) -	Client Alt. Phone ( ) -
Client Email	Marital Status
State	Unsecured Debt
Monthly Income	Is client current or past due?
Is client experiencing financial hardship? Yes No We respect your privacy and do not share your information with third parties. Privacy Policy	(Also note if you have a preferred Debtmerica agent) Comments:
FOR EXPEDITED SERVICE: Please FAX current statements (within 60 days) for ALL unsecured debt accounts over $500. We will contact you to schedule your Free Personalized Debt Analysis with a Senior Debt Consultant ASAP.

Debt Presentation

*Estimates are based on historical results and individual results may vary, including your ability to save sufficient funds to complete our program. When you contact Debtmerica, LLC we will attempt to understand your situation and determine whether you are qualified for our debt resolution programs. Debtmerica, LLC assists with unsecured debt only and any use of “debt free” only applies to accounts that are successfully enrolled in our programs. While we work aggressively to reduce your debt balances, creditors are under no contractual obligation to accept settlement offers from us. Debt reduction percentages do not include program fees and we cannot guarantee that your debt balances will be lowered by a specific amount or percentage or that you will be debt free within a specific time period. However, if at the completion of your program your total debt reduction equals less than three (3) times your service fees paid, we guarantee to refund a portion of those service fees. This refund is calculated so that our service fees will only equal one-third (1/3) of your total debt reduction. We do not assume consumer debt, make monthly payments to creditors or provide tax, bankruptcy, accounting or legal advice and we do not provide credit repair services. Please contact a tax professional to discuss tax consequences of debt settlement. Debt reduction comparisons are based on historical results and individual results may vary depending on creditors in your individual portfolio and underwriting guidelines. By providing your contact information, you agree to receive return telephone calls, emails or other communications from Debtmerica, LLC and/or its affiliates and expressly waive any “No Call” preference or registration. Photographs used are not actual clients. Debtmerica, LLC is not affiliated with MSNBC, Fox, CBS, MarketWatch or USA Today and logos used are registered trademarks of their respective owners. Not available in all states. Read and understand all program materials prior to your enrollment.