CTi may be able to work with you to establish a suitable compromise or payment arrangement to resolve your account. In order to determine if you may qualify for such arrangements CTi must gather Personal Contact information, Personal Financial Information, Employment Information, and References for use in applications to apply for such relief from our client for you. This financial statement covers the basic information that CTi and our clients use to determine if you are eligible for such programs. Please complete the information as completely, thoroughly, and as accurately as possible. Any information that is left out, incomplete or inaccurate may impact your ability to qualify for compromise or payment programs. Once completed the information will be sent to an agent for review to help determine what options are available and you will be contacted to discuss the options that have become available by submitting this application.

Personal Contact Information CTi gathers personal contact information for use in the application for various programs that might be available to you to help resolve this debt. This contact information will also be used to contact you to discuss the options that have become available after this application is completed.
Address
City
State
Zip
Phone Number
Cell Phone

Employment Information In order for CTi and its clients to approve a payment arrangement, CTi must be able to establish where the funds for such payments will come from on a continuing basis. The employment information provided below will allow our Clients to understand how you intend to meet the obligations of the payment arrangement they may offer. In some cases it may be necessary for CTi to verify your employment to ensure that you are eligible for the payment program. CTi understands the importance of privacy in such matters. CTi will only verify your employment to ensure accuracy when necessary.
Employer Name
Position
Date of hire
Employment length
Employer 1 Phone
Extension
Employer 1 Address
Employer 1 City, State, Zip
Employer 2 Name
Employer 2 Phone
Employer 2 Address
Employer 2 City, State, Zip

Personal Financial Information CTi has worked with our clients to determine the key financial aspects that might indicate a hardship or other situation that would be sufficient reason for them to offer a possible compromise of the amount owed to a lesser amount, or to establish a reasonable payment schedule. The questions below will provide information that CTi will use to determine your current financial situation. Accuracy is key, if CTi can arrange a program for you based on this information you may need to provide supporting documentation, bills, and pay stubs to finalize the arrangement. If the information cannot be supported your eligibility for the program may be revoked.
Married	YES NO
Monthly Income
Savings
Checking
Housing Status
Do you own a car?	YES NO
Car's make year?
Monthly car payment
Credit Card
Current Balance
Monthly Payment
Credit Card
Current Balance
Monthly Payment
Credit Card
Current Balance
Credit Card

References Reference information is a critical part of the process. CTi is asking our clients allow you to make either pay a reduced amount to settle your outstanding account, or to allow you to make payments to resolve the account over time. In most circumstances a lender in this situations will require personal references to allow such programs. CTi gathers reference information solely for the purposes of re-establishing contact with you. CTi will never discuss any information with these references other than how to contact you. When completing these references, please ensure that each reference lives at a different address and has a different telephone number from you, and from each other.
Reference 1 Name
Reference 1 Address

Reference 1 City, State, Zip
Reference 1 Home Phone
Reference 1 Work Phone
Reference 2 Name
Reference 2 Address

Reference 2 City, State, Zip
Reference 2 Home Phone
Reference 2 Work Phone
Reference 3 Name
Reference 3 Address

Reference 3 City, State, Zip
Reference 3 Home Phone
Reference 3 Work Phone

Personal Contact Information

Employment Information

Personal Financial Information

References