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Please read the following statements carefully so
that you will understand the provisions of the Debt Management Plan.
Electronically Sign the document
below to indicate your understanding of the provisions. For simplification
the singular is used even when the plural may apply.
I engage the professional
services of agency to provide debt management counseling services in negotiating
a repayment plan hereinafter referred to as the Debt Management Plan or “DMP”
with my creditors. I freely
volunteer to abide by the provisions of this agreement which are as follows:
I understand that I am
responsible for disclosing to agency accurate information, to the best of my
knowledge,
about all of my creditors and sources of income. In consideration of and in
furtherance of services to be provided
by agency, I hereby expressly authorize agency, its employees,
agents/volunteers to:
1.
Disclose any information concerning my financial condition and status,
including but not limited to income, debts, credits, earnings, assets and
residential and work addresses to creditors listed by me unless otherwise
required by law, and;
2.
Obtain whatever financial information concerning me from any creditors,
as agency deems necessary and;
3.
May obtain a copy of my credit report in order to enable agency to better
assess my financial situation and thereby increase its ability to assist me in
the liquidation of my debt. I understand that said credit report will be the
sole property of agency and I will not receive a copy of my credit report. All
information contained in my credit report will be considered confidential and
used for legitimate business purposes under the Fair Credit Reporting Act.
4.
Use a third party to transfer my funds and to receive/send information
about my account to/from my creditors
I agree to deposit with the agency my monthly debt
payments under the repayment plan negotiated by the agency. I agree to make all
deposits by bank check, electronic transfer, certified check or money order made
payable to the agency. I
understand
that agency will not accept cash or personal checks. For the purpose
of the accounting for and the disbursal of my funds, I expressly agree to permit
agency to combine my funds with the funds of other clients being serviced by
agency in a Deposit Account
With respect
to my credit history. I understand that my participation in a debt repayment
program may change information, which is
already on my credit report. If my credit report reflects that I have paid
creditors as agreed in the past, a Debt Management Plan could have a
negative impact on creditworthiness decision by a potential creditor, landlord,
or employer in the future.
With respect to
additional creditor charges and duration of the DMP, I understand that
estimated finance charges, fee or penalties imposed by creditors may increase my
overall indebtedness as well as the length
of time required to fully pay my creditors over and above the estimates provided
by agency. I further understand that
increasing my DMP deposit may have a favorable impact on these charges, reducing
the amount of time estimated to achieve
completion of my DMP. Therefore, as it is in my best interest, I will mak every
effort to increase my deposit whenever possible. Agency will provide as precise
an estimate as possible for the duration
of the DMP. However, a DMP should not extend more than 48 months, unless
otherwise stated.
Termination
of agreement:
1.
I understand that agency reserves the right to discontinue my Debt
Management Plan if I fail to make two (2) consecutive monthly deposits in full
or I make more than four (4) partial deposits in a year’s time totaling less
than fifty (50) percent of my required deposit. Creditor cooperation depends on
consistent payments through agency. A Debt Management Plan can not be re-opened
without re-counseling.
2.
I understand that this agreement can be terminated immediately by agency
if it is found that I have provided any false information to agency, or if I
have paid creditors on my own, or if I fail to comply with any other provisions,
terms, or conditions of this agreement. I understand that I can terminate this
agreement for any reason by providing written notice to agency. If this
agreement is terminated by agency, or me, any money left in my account will be
paid to my creditors, unless otherwise required by law. I understand that if my
DMP is terminated, it is my responsibility to notify my creditors.
3.
I understand that my creditors voluntarily cooperate with agency in this
debt repayment plan. I further understand that if I miss one or more deposits or
make partial deposits, or for any other reason they deem appropriate, my
creditors reserve the right to discontinue any concessions made to me under the
DMP with respect to interest, penalties, and fees.
Other
provisions:
1.
Agency agrees to send me periodic statements of payments made through
agency. I agree to monitor my statements from creditors to verify that payments
have been received and to notify agency of significant differences between the
balances on creditor statements and agency statements. I understand that I have
the right to review my file in the presence of an agency staff member during
regular business hours.
2.
I understand that though a counselor may answer questions about
bankruptcy, agency does not provide legal advice. If legal advice is needed, I
will seek the appropriate assistance.
3.
I understand that agency, in its discretion, may make changes to this
agreement including increases in monthly service charges, by giving me thirty-
(30) days notice.
4.
I understand that authorized agency staff or others with legitimate
authority to monitor agency practices may review my file for quality assurance,
compliance, and research purposes. If such a review should occur, I
understand that my identity will be kept confidential in any finding.
5.
I hereby agree to hold agency, its employees, officers, directors, and
agents harmless from any claim, suit, action or demand made by any of my
creditors and any other person, which in any manner may arise from any action or
inaction taken by agency, or my creditors, in connections with any services
rendered by agency for me.
6.
I instruct you to provide any information that I have given to you
that may be requested by any creditor(s) to whom I owe money and who will be
considering me for a Debt Management Plan.
Usage
of Credit:
I hereby certify that all of my credit cards have either been returned to the
creditor, lost, destroyed, or turned into agency for disposal. I voluntarily
agree that no further charges will be made on the accounts. In the event that
there is no balance on an account, I will request that the creditor close the
account. I further understand and agree that I will not apply for, nor will I
ask anyone for more credit or assume any new debts without prior agency
approval.
I acknowledge that I have
read and understand each of the above provisions, terms, and
conditions of this agreement. Both thye agency and I have received a copy of this
agreement. Agency and I agree that there are no other agreements, promises, or
representations, unless executed in writing between agency and me other than
those contained in this agreement.
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