Fillable Cccs Debt Management Agreement (Page 2 of 2) in pdf

_____ Other provisions:

1. CCCS agrees to send me quarterly statements of payments made through CCCS. I agree to monitor my

statements from creditors to verify that payments have been received and to notify CCCS of significant

differences between the balance on creditor statements and CCCS statements. I understand that I have the

right to review my file in the presence of a CCCS staff member during regular business hours or receive a full

written statement of my account within 2 business days electronically or within 7 days by mail.

2. I understand that though a counselor may answer questions about bankruptcy, CCCS does not provide legal

advice. If legal advice is needed, I will seek appropriate assistance.

3. I understand that CCCS, in its discretion may make changes to this agreement including increases in monthly

service charges, by giving me thirty (30) days written notice.

4. I understand that authorized CCCS staff or others with legitimate authority to monitor CCCS practices may

review my file for quality assurance, compliance, and research purposes. If such review should occur, I

understand that my identity will be kept confidential in any findings.

5. I hereby agree to hold CCCS, its employees, officers, directors, and agents harmless from any claim, suit,

action, or demand made by any of my creditors or any other person, which in any manner may arise from any

action or inaction taken by CCCS or my creditors in connection with any services rendered by CCCS for me.

_____ Usage of credit: I hereby certify that all of my credit cards have either been returned to the creditor, lost,

damaged, or turned into CCCS 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 CCCS approval.

*** The following applies ONLY to settlement companies ***

WE ARE NOT A SETTLEMENT COMPANY

The following is required by Oregon law, but does not apply to the services we provide.

N/A

1. Any cancelled debt may constitute income that is subject to state and federal taxation. If you use a settlement

company, you are advised to consult with a tax professional.

N/A

2. Debt management providers doing debt settlement shall notify your creditors in writing that they may negotiate

with your creditors on your behalf.

I acknowledge that I have read, understand and initialed each of the above provisions, terms, and conditions of this

agreement. Both CCCS and I have received a copy of the information worksheet showing the number of debts included

on the plan, the proposed payment to each creditor, as well as; the total debt owed and the total DMP debt. Both CCCS

and I have received a copy of this agreement. CCCS and I agree that there are no other agreements, promises, or

representations, unless executed in writing between CCCS and me other than those contained in this agreement.

______________________________________

Applicant

Counselor

______________________________________

Applicant

Date

Credit cards destroyed: By CCCS

____

By Client ____

Q & A Handout Provided: YES / NO

Cccs Debt Management Agreement Page 2