*Are your debts making your home life unhappy?

• Yes
• No

*Does the pressure of your debts distract you from your daily work?

• Yes
• No

*Are your debts affecting your reputation?

• Yes
• No

*Do your debts cause you to think less of yourself?

• Yes
• No

*Have you ever given false information in order to obtain credit?

• Yes
• No

*Have you ever made unrealistic promises to your creditors?

• Yes
• No

*Does the pressure of your debts make you careless of the welfare of your family?

• Yes
• No

*Do you ever fear that your employer, family or friends will learn the extent of your total indebtedness?

• Yes
• No

*When faced with a difficult financial situation, does the prospect of borrowing give you an inordinate feeling of relief?

• Yes
• No

*Does the pressure of your debts cause you to have difficulty sleeping?

• Yes
• No

*Has the pressure of your debts ever caused you to consider getting drunk?

• Yes
• No

*Have you ever borrowed money without giving adequate consideration to the rate of interest you are required to pay?

• Yes
• No

*Do you usually expect a negative response when you are subject to a credit investigation?

• Yes
• No

*Have you ever developed a strict regimen for paying off your debts, only to break it under pressure?

• Yes
• No

*Do you justify your debts by telling yourself that you are superior to the "other" people, and when you get your "break" you'll be out of debt overnight?

• Yes
• No