1. Your debt amount
   

   Your debt amount

   This includes any debt you have on store cards or any personal loans that are not secured on your home. This does not include your mortgage.
2. Monthly household income
   
3. Number of companies owed Select... 1 2 3 4 5 6 7 8 9 10 or more
   
4. Monthly disposable income Select... £50 £100 £150 £200 £300 £400 £500 £600 £700 £800 £900 £1000 or more
   

   Monthly disposable income

   The money you have left after essential bills each month.

   Essential bills include:

   • Rent / Mortgage
   • Council Tax
   • Water
   • Gas
   • Electric
   • Food
5. Do you or your partner work? Select... Yes No
   

Further details (How do we keep your details secure?)

1. Title Select... Mr Mrs Miss Ms
   
2. First name
   
3. Last name
   
4. Age
   
5. House name / number
   
6. Postcode
   
7. Country Select... England Scotland Wales Northern Ireland
   

   Why do we need to know where you live?

   Some debt solutions are backed by the government, which means the options available to you can vary depending on where you live.
8. Preferred contact number
   
9. Alternative contact number
   
10. Email address