Defaulted Federal Student Loan Services

Defaulted Federal Student Loan Services

Submit client for Student Loan Services
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Last 4 SSN#*
Family Size*
Adults and Children including the client
Student Loan Providers Ask for TWO (2) references per applicant. Please provide the name, relationship, phone number and address of 2 references for the applicant. They have to be 18 + and can consist of family, friends, co workers etc. They CANNOT have the same address as each other or the applicant.*
Client Valid ID*

Cancelof
Client Paystub dated no more than 90 days if client is employed this is mandatory*

Cancelof
1 month worth of pay stubs. (4 if paid weekly | 2 if monthly or semi monthly | 1 if monthly) This is mandatory for REHAB clients*

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Do you have an ACTIVE GARNISHMENT OR OFFSET?*
Total Student Loan Debt*
Estimated Monthly Payment*
Payment Type*

StandardGraduatedPAYEREPAYEIBRICR
Gross Annual Income*
Employer name and address*
Employment Type*

W2Unemployed1099/SelfRetired
Payment Structure*

WeeklyBiweeklyBi MonthlyMonthly
Tax filing status*

SingleHead Of HouseholdJoint MarriedSeparated Married
What service do you need? Select all that apply*

ConsolidationForgivnessREHABIDR
Any additional notes you'd like to share for this application that would be helpful?*
We will process the client's file with the information that has been provided in this form. We are NOT liable for any difference in the client's program if the information I have provided is incorrect. I understand that I am not eligible for a refund of the fee *
My Products
prevnext( X )
Fee
Consolidation, income-driven repayment program and/or public service loan forgiveness one time Annual Fee

$297.00

Rehab 2
Rehab one time annual fee

$597.00

Total

$0.00
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