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Eltman Law Hardship Application
Please be prepared to send in documentation to support all of your answers. Upon review of your application, our consumer advocate will contact you.

Please note that the information you submit on this page will NOT be shared with any collections personnel.

Are you employed? *
Are you experiencing a temporary or permanent hardship? *
Was there a recent death in your family that is causing undue hardship? *
Is there a recent or existing illness or disability that is causing hardship? *
Do you receive any public benefits/assistance? *
Are you the head of household or primary provider? *
How many people do you care for/support? *
Your answer
Do you receive any support from other family members or other sources? *
Are you living on fixed income? *
Do you own a home? *
What is your total household income? *
Your answer
Are you a military service member or a spouse of a service member? *
How much do you spend on groceries and household items each month? *
Your answer
Is there anything else we should know about your current situation? *
Your answer
Please provide your full name and/or Eltman Account Number for reference. *
Your answer
How should we contact you? *
Your answer
Thank you for applying for our Hardship Program.
The information you have submitted through this form will NOT be shared with any collections personnel at Eltman Law.
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