NOTE: ConsoliGrant does NOT charge consulting fees to complete a grant application! If you are being asked to pay for filing assistance, please check with the person who referred you to our services.

Individual Grants
Application

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For optimum performance, we recommend using a laptop or desktop computer for application submissions.

Name of Who Referred You

Individual Grants

Please Complete the Following

Your Name

Your Street Address

City/State/Zip

Employer Name

Your Email

Repeat Your Email

Your Cell Phone

Repeat Your Cell Phone

Tell us what you are applying for:

NOTE: If your answer is none or zero, state "0".

How many mortgages do you wish to include?

Estimated Total Mortgage Amount

Total of Monthly Payments

How many leases do you wish to include?

Estimated Total Lease Amount

Monthly Lease Payments

How many vehicles do you wish to include?

Estimated Total Car Loans

Total of Monthly Payments

How many credit cards do you wish to include?

Estimated Total Debt

Total of Monthly Payments

Total of Other Debt Monthly Payments

If yes, state the type of debt and the monthly payment.

NOTE: A minimum monthly payment threshold of $1,000 applies to each mortgage or to a single mortgage coupled with revolving debt. Detailed information and documentation will be requested and required for all debts included in this application once your grant is approved. No debt without finite payoff dates will be considered (i.e. recurring household expenses, utilities, etc.)

Do you have any late pays on any of your accounts?

Yes

In the past 6 months

6-12 months

Over 12 months

Have you changed the due date of the account(s) for which you are applying in the last 12 months?

1 time

2 times

Are you currently in foreclosure and/or modification proceedings?

Yes

If so, do you require financial or legal assistance to stop proceedings?

Yes

If choosing Option 1, do you have immediate access to the matching funds required (i.e. 30% GTV)?

Yes

I authorize the following person(s) to act on my behalf, including sending/receiving information and/or conducting business if I am unable to do so:

I understand that NO ONE may advocate, inquire or transact for me and/or my account if not named here (other than ConsoliGrant, Inc. and Ameritax Financial). I further understand that I cannot advocate, inquire or transact on someone else"s account without their written consent. Failure to comply will result in the cancellation of grants for all parties involved.

I understand there is no fee for my grant. However, A FEE OF $99.99 WILL BE ASSESSED MONTHLY BY AMERITAX FINANCIAL BEGINNING TODAY for asset management of my existing debt up to 10 bills per month and $9.99 per bill thereafter. I further understand that the first monthly payment of $99.99 is due with this application and will continue every month until the end of my program term, including the three months of the initial 90-day set-up period. I authorize Ameritax Financial to draft these funds from my credit/debit card below without any retaliation or chargeback initiated by me:

Credit Card Information

Card Number

Exp. Date

3-Digit Code

Billing Address

I understand that funds drafted from this card will incur a 3.1% merchant processing fee. I further understand that, by checking this box, I am authorizing this payment.

If I have chosen the Accelerated Option 1, I understand that my GTV portion of 30% will be due within 14 days of my acceptance, and I am ready to proceed. I understand this will be paid via bank wire transfer, e-Check or ACH debit/credit (ACH transactions will include a 3.1% merchant service fee).

I understand this Program requires a security deposit equal to one month of my combined total regular payment for each debt submitted. I UNDERSTAND THIS AMOUNT MUST BE SENT VIA ZELLE from my bank account to Ameritax Financial (send to payments@ameritaxfc.com) TODAY WITH THIS APPLICATION OR THIS APPLICATION WILL BE VOID. I further understand that my security deposit is nonrefundable, and that it will be applied to my payoff at the end of my program term.

TOTAL Security Deposit Amount

I Have Choosen To:

Option 1 (2-year): Pay the full amount today.

Option 2 (3-year): Pay the full amount today.

Option 3 (4-year): Pay 1/2 now and the remainder in 30 days.

Option 4 (5-year): Pay 1/3 for three consecutive months. .

I understand that I will receive a private and secured portal invitation to the email address I provided within 7 days of this application date (NOTE: Please watch your email, spam and promotional folders). I further understand that I must activate my portal and upload all required documents within the 7 days following the portal invitation. Failure to do so will automatically cancel my grant and this application, without exception. (Additional fees will apply to reinstate the application process.)

I understand there will be an administrative wait period of 90 days before my grant program actually begins. I agree to continue making my regular debt payments on time now and for the duration of my grant term.

I understand that my combined total regular monthly payments will be due on the 30th of each month and that my bills/debts will NOT be paid if I do not pay. I understand that a 15% late fee will be charged if I am more than 3 calendar days late. I further understand that failure to pay within 7 calendar days of the 30th will be an automatic and total cancellation of my grant and forfeiture of my security deposit.

I understand that I must pay my lender(s) on or before the due date or within the grace period specified by each lender/provider. I further understand that it is my responsibility to upload proof of each payment into the "Files" section of my private portal every month for my grant program to be valid.

I understand that all government-backed debt (i.e. IRS tax debt, student loans, etc.) are accepted only on a case-by-case basis following assessment by our Review Board and, if accepted, will be a minimum 3-year program.

I understand that, if I am in foreclosure and/or modification proceedings, my grant term will not begin until my account is brought current.

I understand that the term of my program begins when my first monthly payment is made.

I agree to accept text messaging and promotional and/or information emails from ConsoliGrant, Inc. as communication platforms regarding my accounts and/or program status.

I understand I may be eliminated from this program if I miss even one payment. I further understand I will be eliminated from this program if I initiate any chargebacks on fees I have agreed to herein.

I understand I may choose to cancel this regstration within 7 days of today and receive a full refund minus a 20% administrative fee. If I cancel after 7 days, I forfeit any monies paid to that time.

I certify that I am of legal age, that I am the debtor of record on the above named debts, that I am of sound mind, and that I have not been coerced or pressured to enter into this program.

I certify that I have read and agree to the Terms & Conditions posted on this website.View Terms & Conditions.

I certify that I have read and agree to the Privacy Policy posted on this website.View Privacy Policy.

I certify that I have read and agree to the Cancellation/Refund Policy posted on this website.View Cancellation/Refund Policy.

I understand this is a grant. I do not have to pay it back! I agree to PAY IT FORWARD and bless people I love by enrolling someone into this program within the first 90 days and someone within the last 90 days of my program.

As stated above, this Program requires a security deposit equal to one month of your combined total regular payment for each debt submitted. BEFORE CLICKING THE SUBMIT BUTTON BELOW, ZELLE your total security deposit to Ameritax Financial (taxes@ameritaxfc.com) now. Failure to do so will VOID this application.

Choose One:

I have sent my security deposit via ZELLE as required to payments@ameritaxfc.com.

My bank has a daily cap on ZELLE transactions, and I have exceeded that amount here. I have sent the initial payment today and agree to send the remainder of my securty deposit via ZELLE within 24 hours. I understand that failure to do so will void this application.

I do not have access to ZELLE. I authorize you to charge the credit card listed above for my security deposit plus a 3.5% convenience fee TODAY. I understand if my card is declined for any reason, my application is immediately void.

Your application has been successfully submitted and is now processing. If your payment is received in our office by 11:00 AM CST, it will be processed the same day. Payments received after 11:00 AM CST will be processed the following business day.

Ameritax Financial is our accounting division. All payments will be sent to or drafted from them. Use ZELLE to send your security deposit now to payments@ameritaxfc.com.

Please watch your email inbox, spam and program

files for mail from Support@ConsoliGrant.com.

We consider applicants for all grants without regard to race, color, religion, creed, gender,

national origin, age, disability, marital or veteran status, or any other status protected by law.

NOTE: ConsoliGrant does NOT charge consulting fees to complete a grant application! If you are being asked to pay for filing assistance, please check with the person who referred you to our services.

Individual Grants Application

Individual Grants

Please Complete the Following

S T O P

Individual Grants
Application