Liberty Debt Resolution Application

Step 1 : Personal Details

* Marked fields are required

First Name*

Last Name*

Date of Birth*

Mobile Number*

Email*

State*

Home Address*

Zip Code*

Estimated Debt Range*

Is all the debt yours or shared?*

Appointment Time Preference*

Time Zone*

Step 2 : Income & Assets

This information will be reviewed as part of your enrollment process and does not guarantee program eligibility. All income values should be reported as monthly amounts.

Applicant’s Take-home (Monthly Net) Pay

Spouse’s Take-home (Monthly Net) Pay

How do you currently get paid?

Do you receive Social Security income?

Do you receive Retirement Income?

Do you receive Alimony Income?

Do you receive Child Support?

Do you own a paid-off vehicle?

Do you receive Rental Income ?

Do you receive any Additional Income?

Checking Account Average Balance

Savings Account Average Balance

Step 3 : Monthly Debt Analysis

Let’s Dive Into Your Monthly Expenses

To build a plan tailored to your needs, we’ll need to review your current expenses. Please provide the most accurate monthly figures for the items below. All expenses should be reported in monthly amounts.

Property Tax/Homeowners Insurance/Renters Insurance

Memberships/Subscriptions (Costco, Sam's, etc), gym, food delivery

Home Repair, Maintenance, Association Dues

Internet/Cable TV/Streaming Services

Electric, Gas, Heating Oil

Insurance (Vehicle, Health, Life, Pet, etc.)

Water, Sewage, Trash Collection

Home/Mobile Phone Services

Groceries

Clothing, Haircuts, Dry Cleaning, Laundry

Misc. Household Expenses/Toiletries

Gifts, Donations, Charity

Entertainment / Restaurants

Car Payments

Vehicle Insurance

Vehicle expenses (gas, maintenance, registration)

Child Care

Dependent Care/Activities

Pet Expenses

Student Loan Monthly Payments

Health/Life Insurance

Medical (Doctor/Dentist/Past-Due Medical Bills)

Child Support/Alimony Expense

Other Expenses

Step 4 : Liabilities

Let’s Review Your Liabilities

To better understand your financial position, please answer the questions below about any outstanding debts or obligations

Do you have stockbroker licenses or other certifications?

Do you own your own business?

Does the Business have over $336,000 in unsecured assets?

Are you a cosigner for any loans?

Do you have any Lawsuits or Judgments?

What is the co-applicant's relationship to you? (if applicable)

Do you have any Pending Foreclosures?

Marital Status

Do you have any Pending Repossessions?

How many people are currently living in your home?

Do you have any Pending Past Due Taxes?

What is the name of your employer?

Do you have any Credit Union Accounts?

What is your Occupation?

Do you have Over $500 in bonds/CDs/savings?

Do you have any Cash Advance or Payday loans?

If yes, what type is the business (DBA, LLC, Corp.)?

Do you have any Memberships?

Gross Monthly Income (Last 6 Months):

Do you have any Timeshares?

Do you have any Equipment or Building Leases?

Other Expenses (list below)

Additional Debt Liabilities Details

Student Loan Total Balance – Estimated

Auto Loan 1 Past Due (Monthly x Months)

Auto Loan 2 Balance

Student Loan Monthly Payment – Estimate

Auto Loan 2 Monthly Payment

Mortgage Balance (Total – NOT Monthly)

Auto Loan 2 Past Due (Monthly x Months)

Mortgage Past Due Amount

Recreation Vehicle Balance

Auto Loan 1 Balance

Recreation Vehicle Payment

Auto Loan 1 Monthly Payment

Recreation Vehicle Past Due (Monthly x Months)