Free Consultation: 760-776-8899

Welcome ! We will email your report, "7 Mistakes Keeping you in Debt". Here is the first video - you can also check out our Video Learning Center for more information.

APPLICATION: Note this is just an application and not yet binding to either party. We will use this data to provide you more specifics and get you moving forward.

APPLICANT
Applicant Full Name:
Email:
Cell Phone:
Work Phone:
Home Phone:
Preferred...:
Street:
City:
State, Zip:
Date of Birth:
Employer Name:
Job Description:
CO-APPLICANT
Co-Applicant Full Name:
Co-Applicant Phone:
Co-Applicant Email:
Co-Applicant Cell Phone:
Co-Applicant Work Phone:
Co-Applicant Home Phone:
Date of Birth:
Employer Name:
Job Description:
If the Co-Applicant is NOT at the same address, please check here. (Example: Divorce)
IF YOU PREFER you can simply fax all statements to us at 760-776-8899 instead of filling out this section. We will review each statement and set this up for you.
  Creditor Acct Number Balance  
Account 1  
Account 2  
Account 3  
Account 4  
Account 5  
Account 6  
Account 7  
Account 8  
Account 9  
Account 10  
Account 11  
Account 12  

Hardship Description: Which of the following apply?

loss of job
loss of income
divorce
medical
other (List below)
In your own words, please describe a hardship description, why you cannot pay your bills.

Comments? Questions? Concerns? (We'll call to confirm details)

I agree to the Terms & Conditions. I understand this is a non-binding application to either party, but is simply an authorization to reseach my account and let me know if I qualify and if so, obtain a debt savings quote.

If you qualify, you will be contacted within 1 working day to confirm details. You will NOT be enrolled, nor liable for any fees, nor fully committed into the program until we speak with you, to be 100% sure you have any questions answered.

FREE CONSULTATION
How Much Can Whitehall Company Help You Save?

Name
Email
Home Phone
Phone
Address
Zip Code

QUESTIONS?
Call Now Direct
760-776-8899

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Whitehall Company, LLC is an
Equal Opportunity Provider.

Whitehall Company is a provider of Debt Settlement Services. 
© 2009 Whitehall Company, LLC. All rights reserved. Use of this website is subject to our Terms & Conditions.

This web site is for informational purposes only and not to be construed as legal advice and is not a substitute for legal advice.
We make no promises or guarantees about specific performance, as each person’s situation is different. 
Only by consultation with you can we determine if our program would benefit you.
The debt settlement process has inherent risks, and should only be considered in lieu of bankruptcy or legitimate financial hardship.
Debt Settlement will result in short-term damage to a participant's credit score, with potential for strong long-term benefit.
Tax implications may occur as a result of forgiven debt; please speak to a qualified and licensed tax professional for specific advice.
We are committed to doing business ethically, legally, and encourage you to ask questions to be sure our services are the right decision for you.

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