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  5. CCCS media form

CCCS media form

 
 
Thank you for taking the time to complete this form.

By you submitting your details to take part in media activity you are helping the Consumer Credit Counselling Service let people in financial difficulty know how we can help them.

Once you submit your details, you have provided consent for us to contact you to see if you would be interested in helping us with requests that match your situation. This is not a contract between us, therefore you are free to withdraw from any activity at any time and will no longer be contacted about media requests.

Please complete all answered marked with an asterisk.
 
 
 
* Please confirm that you are willing to provide your consent to take part in media activities
 
Yes
 
No
 
 
 
* Please tick which type of activity you are willing to take part in
(Tick as many as you wish)
 
TV
 
Radio
 
Newspaper / magazines (including internet articles)
 
CCCS website

 
 
 
* Have you been involved in any media activity before?
 
Yes
 
No
 
 
 
Please provide us with some details of the media activity you were involved in
   
 
 
 
* Do you wish to remain anonymous?
 
Yes
 
No
 
 
 
Please provide a brief description of how you got into financial difficulties and how we have helped you
   
 
 
 
* Please tick which debt solution we recommended you
 
Administration Order
 
Bankruptcy
 
Debt Relief Order (DRO)
 
Debt Management Plan (DMP)
 
Equity Release
 
Income Maximisation
 
Individual Voluntary Arrangement (IVA)
 
Low Income Low Assets (LILA)
 
Pro rata payments
 
Sequestration
 
Token Payments
 
Trust Deed
 
Other, please specify
 
 
 
 
* Please enter your CCCS client reference number (this will be on all correspondence we have sent you)
   
 
 
 
* Please enter your preferred telephone number for us to contact you on
   
 
 
 
If you have an alternative email address you would prefer us to contact you on, please enter this
   
 
 
 
* Please tick which method you would prefer us to contact you by in the future
 
Email
 
Telephone
 
Post
 
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