You must be gainfully employed and earn a minimum of R6,000.00 per month. Stokvels, family loans and shareholder
loans may not be included when calculating the total value of your exsiting debt. Should you meet these criteria,
please complete the application form below and a consultant from United Debt Counsellors will contact you shortly.
Please note: All infomation provided by you is kept strictly confidential and will not be resold or used for any other reason.
In which province do you reside?
Please select... Gauteng KwaZulu-Natal Limpopo Mpumalanga North West The Eastern Cape The Free State The Northern Cape The Western Cape
What is the combined value of your current Debt? (estimate)
How much do you pay towards your debt each month? (estimate)
What is your total monthly household income? (Net)
Title:
Please select... Dr Miss Mr Mrs
First Name:
Last Name:
Telephone #
Mobile #
Email Address:
Confirm your Email Address:
Do you own property?
Please select... Yes No
Preferred Contact Method:
Please select... Email Telephone Mobile
Preferred Contact Time:
Please select... Anytime Between 08h00 and 11h00 Between 11h00 and 14h00 Between 14h00 and 17h00
I have read and agree to the Terms and Conditions as expressed by Quick Compare (Pty) Ltd.