Credit Card Debt	$ Select One 0 1 - 2,499 2,500 - 4,999 5,000 - 7,499 7,500 - 9,999 10,000 - 12,499 12,500 - 14,999 15,000 - 19,999 20,000 - 29,999 30,000 - 39,999 40,000 - 49,999 50000+
Other Unsecured Debt	$ Select One 0 1 - 2,499 2,500 - 4,999 5,000 - 7,499 7,500 - 9,999 10,000 - 12,499 12,500 - 14,999 15,000 - 19,999 20,000 - 29,999 30,000 - 39,999 40,000 - 49,999 50000+
Number of Creditors	Select One 2 3 4+
Status of Bill Payments	Select One Up to Date About to Fall Behind 1 Month Behind 2 or More Months Behind
I want to	Select One Eliminate My Debt Consolidate My Debt Seek Advice
Own a Home?	Yes  No

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