Evaluation Form

Name: Phone Number: E-mail: Number of people in your household: Monthly net income of your household: $ Total amount of debts owing: $ Types of debts: Credit Cards Bank Loans Personal Loans Other Loans Mortgage Tax Debt Student Loans Support Payments/Alimony Do you have any assets? Yes    No Types of assets: RRSP's Life Insurance House, Cottage or Land Mobile Home Automobile Other: