No Cost Evaluation

Lifeline Consulting Group, Inc. is well qualified to discuss your situation and provide an evaluation of how our services may be able to assist you to recover from overwhelming or troublesome debts, trouble vendors and other unresolved obligations.

Please fill out and submit the form below. We will have a representative contact you promptly, in most cases within 24-48 hours of receipt of your information. (Your data is protected by our Privacy Policy.)

Please fill out all fields below

Note: If you wish to obtain immediate assistance, please contact us by phone at 1-800-822-4122.

First name:	Phone:	Ext.
Last name:	Mobile Phone:	Ext.
Title:	Email:
Company:	Company URL:

Total Number of Employees:
Gross Annual Revenue:
Total Business Debt:
Total Number of Creditors:

Types of Debt:

Real Estate

Judgments or Liens

Credit Cards

In Collections

Lease Debt

Attorney Involvement

Vendor

Is the business incorporated?
Yes No

Do you have UCC filings?
Yes No

Do you have debts with a personal guarantee?
Yes No

Approximately what percentage of the business debts are unsecured?

Tell us about your situation:

Urgent				please contact me as soon as possible