National Credit Help Application

Please complete the following application in as much detail as possible. Once completed, your application is electronically forwarded to National Credit Help who will contact you for a personalized evaluation of your needs and he/she will explain your next step. It's that simple!

Please note that you are about to voluntarily provide personal information to us. We are committed to protecting all of the information you give us.

WHO YOU ARE

Full Name	Birth Date yyyy-mm-dd	S.I.N.	Marital Status	Dependents
Applicant (required)	(required)

HOW TO CONTACT YOU

Home Phone	Work Phone	Fax Number	Email Address
Applicant (required)	(required)

WHERE YOU LIVE - (3 Year History)

Street Address	City, Province, Postal Code	How Long (Yrs)	Status
Present

Previous

Previous

WHERE YOU WORK - (3 Year History)

Employer	Full Address	Position	How Long (Yrs)	Income/Year
Applicant

ADDITIONAL COMMENTS REGARDING YOUR APPLICATION

I, the applicant, name here in, authorize National Credit Help to obtain information about me as permitted by law; share information (including my Social Insurance Number) about my application and credit history with other credit grantors, credit bureau’s, suppliers of services to use my information with the express purpose to rectify my credit situation and sharing information with my creditors to help resolve my situation.