DebtFreeAmerica.com
P.O. Box 9228
Virginia Beach, VA 23450
(757) 340-2564 Fax (757) 498-6432
Toll Free (800) 4-0-DEBTS
Toll Free Fax (800) 256-3504
Listing of Creditors
Name of Creditor:______________________________
Account #______________________________
Address:____________________________________________
Phone:(______) _________ - ______________
City:__________________________
State:______________
Zip:__________________
Balance:$_______________________
Due Date:______/______/______
Monthly Payment:$___________
Name of Creditor:______________________________
Account #______________________________
Address:____________________________________________
Phone:(______) _________ - ______________
City:__________________________
State:______________
Zip:__________________
Balance:$_______________________
Due Date:______/______/______
Monthly Payment:$___________
Name of Creditor:______________________________
Account #______________________________
Address:____________________________________________
Phone:(______) _________ - ______________
City:__________________________
State:______________
Zip:__________________
Balance:$_______________________
Due Date:______/______/______
Monthly Payment:$___________
Name of Creditor:______________________________
Account #______________________________
Address:____________________________________________
Phone:(______) _________ - ______________
City:__________________________
State:______________
Zip:__________________
Balance:$_______________________
Due Date:______/______/______
Monthly Payment:$___________
Name of Creditor:______________________________
Account #______________________________
Address:____________________________________________
Phone:(______) _________ - ______________
City:__________________________
State:______________
Zip:__________________
Balance:$_______________________
Due Date:______/______/______
Monthly Payment:$___________
Name of Creditor:______________________________
Account #______________________________
Address:____________________________________________
Phone:(______) _________ - ______________
City:__________________________
State:______________
Zip:__________________
Balance:$_______________________
Due Date:______/______/______
Monthly Payment:$___________
Print additional copies of this sheet if you have more than 6 creditors to list.
** For verification of accuracy, include
current copies
of most recent statements **
