Sign Up for Free Counseling

Before starting your free counseling session, you should review the alternatives to bankruptcy described on this site.

This counseling session is for:

You reside in:

You may not use this website if you live
in the State of Alabama or the State of
North Carolina

Your full name (first and last): Be sure your name is spelled correctly!

Your Age

Last 4 digits of your social security number:

Your e-mail address will be used to send you important information about your consulting session, and your certificate of completion. You must provide a valid e-mail address. If your address is protected by a service that requires pre-approval, like Earthlink SpamBlocker or BoxBe, you may not receive important information.

Your e-mail address:

Retype your e-mail address to confirm:

Your marital status:

Number of adults living in household:

Number of minor children in household:

If this is a joint counseling session:

If this is a joint counseling session, both spouses must be present throughout the session.

Your spouse's full name: Be sure this name is spelled correctly!

Your spouse's age:

Last 4 digits of spouse's social security number:

Please select a password in order to log in to the system later to obtain your counseling results:

Password:

Retype password to confirm:


	By entering this counseling session, I confirm that I am the person identified above and that all the information entered in this and subsequent worksheets is accurate to the best of my knowledge.

Please check all information before continuing