Northwest Consumer Law Center


Apply for Legal Help - Debt Collection
Please fill out this form if you are seeking legal assistance from Northwest Consumer Law Center regarding a debt collection issue.
Contact & Demographic Information
Your contact information:
First Name *
Last Name *
Preferred Name *
Pronouns *
Email *
Phone *
Address 1 *
City *
State/Province *
County
Zip *
I prefer that you contact me via: *
How did you hear about us? *
Would you like to be added to our email list to get updates about our organization including success stories and advocacy updates? *

Your demographic information:
Your demographic information does not affect our ability to provide legal assistance. If you do not wish to provide any demographic information, please select "prefer not to answer" on each of the drop down boxes.
Gender *
Date of Birth: *
Race: *
Are you a veteran? *
Are you active duty? *
Sexual Orientation: *
Do you identify as transgender? *
Do you have a disability? *

Your financial information:
Please note that NWCLC is only able to serve those with a total household income under 500% of the Federal Poverty Level:
How many people live in your household that you support (or that support you)? *
What is your total gross (pre-tax) monthly income? Include all sources of income including employment, Social Security, food stamps, etc. *

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