Client Info Sheet Page 3
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1
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4Debt Worksheet
CCCS of Buffalo
Instructions:
•
List all your outstanding unsecured debts
This includes all credit cards (such as Discover and American Express) retail store cards, finance
o
company loans, collection agencies, judgments and medical bills
Do not include mortgages, auto loans, student loans and utilities
o
•
If the account is with Collection Agency or Attorney list the name of the collection or attorney’s
office the account is currently handled by
•
Please round to the nearest dollar
•
Bring your most recent creditor statements and full account numbers
Creditor/Collection/Attorney
Current
APR/
Payment
Balance
Interest
rate
1
$ 0
0.00
$ 0
2
$ 0
0.00
$ 0
3
$ 0
0.00
$ 0
4
$ 0
0.00
$ 0
5
$ 0
0.00
$ 0
6
$ 0
0.00
$ 0
7
$ 0
0.00
$ 0
8
$ 0
0.00
$ 0
9
$ 0
0.00
$ 0
10
$ 0
0.00
$ 0
11
$ 0
0.00
$ 0
12
$ 0
0.00
$ 0
13
$ 0
0.00
$ 0
14
$ 0
0.00
$ 0
15
$ 0
0.00
$ 0
16
$ 0
0.00
$ 0
17
$ 0
0.00
$ 0
18
$ 0
0.00
$ 0
19
$ 0
0.00
$ 0
20
$ 0
0.00
$ 0
21
$ 0
0.00
$ 0
22
$ 0
0.00
$ 0
23
$ 0
0.00
$ 0
24
$ 0
0.00
$ 0
25
$ 0
0.00
$ 0
•
Your credit report will be pulled during the appointment to verify your debt and creditors
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