Creditaid: Helping Canadians Be Debt Free Since 1992

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Homepage Assessment
Free Quick Assessment
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Creditaid Full Assessment

We will use this confidential information to review your financial situation and provide recommendations on how we can help you.

Please fill in all pages of the following form. All fields marked with an asterisk (*) are required.

Creditaid Long Form

Step 1: Personal Information

*Indicates required information.

Step 1 of 6
How did you hear about us? (*)
Must choose a valid option before proceeding.
First Name (*)
First Name is Required
Last Name (*)
Last Name is Required.
Email Address (*)
Valid email address required.
Home Phone
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Mobile Phone
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Work Phone
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Spouse's Information
Spouse's First Name
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Spouse's Last Name
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Spouse's Email Address
Enter Valid Email Address
Spouse's Home Phone
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Spouse's Work Phone
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Spouse's Mobile Phone
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Home Address
Street Address
Address is required.
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City
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Province
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Postal Code
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Number of Dependants
Please enter only numbers
Best time to contact you
Must choose a valid option before proceeding.
   

Step 2: Employment Information

Please enter your employment information.

Step 2 of 6
Employer
Enter name of company here.
Employer's Address
Enter Workplace Address.
Occupation
Enter job title.
Length of Employment
Enter number of years of employment.
Spouse's Information
Spouse's Employer
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Spouse's Employer Address
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Spouse's Occupation
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Spouse's Length of Employment
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Step 3: Monthly Income

Please enter your monthly income information.

Step 3 of 6
Gross Income
Must enter information before proceeding.
Net Income
Must enter information before proceeding.
CPP
Must enter information before proceeding.
OAS
Must enter information before proceeding.
Child Tax Benefit
Must enter information before proceeding.
Support
Must enter information before proceeding.
Other
Must enter information before proceeding.
Spouse's Income
Spouse Gross Income
Must enter information before proceeding.
If no spousal income, enter "0"
Spouse Net Income
Must enter information before proceeding.
Spouse CPP
Must enter information before proceeding.
Spouse OAS
Must enter information before proceeding.
Spouse Child Tax Benefit
Must enter information before proceeding.
Spouse Other
Must enter information before proceeding.
   

Step 4: Monthly Expenses

Please enter your monthly expenses.

Step 4 of 6
HOUSING
Mortgage
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2nd Mortgage
Must enter information before proceeding.
Rent/Strata Fees
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Property Taxes
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Maintenance & Repairs
Must enter information before proceeding.
Insurance (Home/Content)
Must enter information before proceeding.
UTILITIES
Hydro/Electricity/Gas
Must enter information before proceeding.
Water
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Telephone
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Mobile Cellular
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Cable/Internet
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Other
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Other
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Other
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GENERAL
Food
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Clothing & Personal Care
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Child Care
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Alimony/Child Support
Must enter information before proceeding.
Medical/Life Insurance
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Drugs/Dental/Medical Travel
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Recreation
Must enter information before proceeding.
Auto Loan(s)
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Auto Insurance
Must enter information before proceeding.
Auto Expenses (Gas & Maintenance)
Must enter information before proceeding.
Transportation
Must enter information before proceeding.
Lunch/Coffee Breaks
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Alcohol/Tobacco
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Pet Food
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Step 5: Assets

Please provide an estimated value of your assets.

Step 5 of 6
Savings Account
Must enter information before proceeding.
Home Value/Equity
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Vehicle Value
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Vehicle Value
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Other Assets
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RRSP/Investments
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Step 6: Liabilities

Please provide information on all debt, secured or unsecured.

Step 6 is the final section
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
   

Step 6a: Liabilities Continued

Please provide information on all debt, secured or unsecured.

Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
   

Step 6b: Liabilities Continued

Please provide information on all debt, secured or unsecured.

Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
   

Step 6c: Liabilities Continued

Please provide information on all debt, secured or unsecured.

FINAL SECTION
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
Name of Financial Institution/Credit Card
Must enter information before proceeding.
Type of Credit
Must enter information before proceeding.
Balance Owing
Must enter information before proceeding.
Monthly Payment
Must enter information before proceeding.
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