Please enable JavaScript in your browser to complete this form.Primary Burden--Unaffordable DebtCredit ScoreSecurity ClearanceCollection HarrassmentWhat has you reaching out for help today? If it is not on this list, we may not be the right firm for you.Account Status--Current On AllBehind On SomeBehind On AllNumber of Accounts--12-55-910+Eligible debt includes credit cards, medical debt, personal loans and other accounts that are not secured by collateral.If you had a denial, was it related to debt or credit?--YesNoReview Has Not Yet OccurredState *--ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYTotal Debt Amount Selected Value: 20000 Approximate Credit Score Selected Value: 500 Details About Your SituationText Message AuthorizationI Consent To Receiving Text MessagesBy checking this box you agree that the phone number you are providing to us may be used to contact you by The Law Office of Fox, Kohler & Associates, dba National Legal Center (including autodialed and prerecorded calls, as well as text/SMS messages) even if you have listed yourself on any Do-Not-Call List. Msg and data rates apply, and your consent to such contact is not required for purchase.Submit