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Debt Management Credit Counceling

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					        CONSUMER CREDIT COUNSELING SERVICE OF NORTH CENTRAL WV
                     A SERVICE OF CRISS-CROSS, INC.

                           DEBT MANAGEMENT AGREEMENT

        This Debt Management Agreement (“Agreement”) is entered into as of the _______ day
of ______________, 20____, by and between CONSUMER CREDIT COUNSELING OF
NORTH CENTRAL WV (the Agency) and __________________________________________
(the Client) for professional debt management counseling services in negotiating a repayment
plan (“Debt Management Plan”). By initialing the line next to a section, Client hereby
acknowledges that Client has read, understands and agrees to the terms and conditions of that
section.


__________ A. Engagement:
           1. Client engages the Agency to provide a Debt Management Plan with Client’s
              creditors. Client freely volunteers to abide by the provisions of this agreement.

             2. Client acknowledges that (a) creditors of Client may choose not to participate
                in the Debt Management Plan, and (b) Client may incur finance charges, fees
                or penalties imposed by creditor(s) who choose not to accept a payment from
                the Agency or participate in the Debt Management Program.


__________ B. Authorization:
           Client agrees to disclose to the Agency accurate information, to the best of Client’s
           knowledge, about all of Client’s creditors and sources of income. In consideration
           of and in furtherance of services to be provided by the Agency, Client hereby
           expressly authorized the Agency, its employees, agents and/or volunteers to:

              1. Disclose any and all information concerning Client’s financial condition
                 including, but not limited to, income, debts, credits, earnings, assets and
                 residential and work address to any creditor listed by Client or as otherwise
                 required by law;

              2. Obtain any and all financial information concerning Client from Client’s
                 creditors, as the Agency, in its sole and absolute discretion, deems necessary;
                 and

              3. Obtain a copy of Client’s credit report in order to enable the Agency to assess
                 Client’s financial situation and thereby increase its ability to assist Client in
                 the liquidation of Client’s debt. Client’s credit report shall be the sole property
                 of the Agency, and Client shall not be entitled to receive a copy of Client’s
                 credit report. All information contained in Client’s credit report shall be
                 considered confidential and shall only be used for legitimate business purposes
                 under the Fair Credit Reporting Act.
__________ C. Information:
           Client hereby authorizes and instructs the Agency to provide any and all
           information Client has provided to the Agency to any creditor(s) to whom Client
           owes money and who may consider Client for a Debt Management Plan, as and
           when requested by such creditor.


__________ D. Deposits:
           1. Client’s FIRST monthly payment will be $ __________. This amount includes
              $1.00 set up fee for each account, maximum $15.00 or an education reentry
              fee.

             2. Client’s REGULAR monthly deposit will be $ __________. This includes
                $ __________ for a monthly maintenance fee, $ __________ for ACH fee,
                which will be retained by the Agency.

             3. Client must make the initial deposit by the second Wednesday of the month
                which they are entering the program. Client must make all remaining deposits
                by the 17th of each calendar month thereafter. The Agency may co-mingle
                Client’s funds with the funds of other clients served by the Agency in a single
                deposit account for the purpose of the accounting and disbursal of Client’s
                funds.

             4. Client shall make every effort to increase Client’s monthly deposit in order to
                reduce the amount of time estimated to complete the Debt Management Plan.

             5. The Agency shall apply the funds from each deposit first to the monthly
                maintenance fee, as disclosed in Section D(2) herein above, and then to
                Client’s creditors in the amount of the proposed payments as disclosed in
                Client’s General Information Worksheet, which may be amended from time to
                time.

             6. Client hereby acknowledges that creditor of Client may choose not to accept
                the proposed payment from the Agency or participate in the Debt Management
                Plan and the Client may incur finance charges, fees or penalties as a result
                thereof. Client does hereby release, acquit and discharge the Agency of and
                from all claims, demands, actions, causes of action, losses, damages and
                expenses of whatsoever kind and nature, arising directly or indirectly, out of
                any finance charges, fees or penalties, and/or any other actions taken by
                Client’s creditors against Client, as the result of the refusal of one or more of
                Client’s creditors to accept the proposed payments from the Agency or
                participate in the Debt Management Plan.
             7. All missed and partial payments to Consumer Credit Counseling Service must
                be brought current within 90 days. Failure to do so will result in termination.
__________ E. Client’s Credit Report:
           With respect to Client’s credit history, Client acknowledges that participation in the
           Debt Management Plan may affect Client’s credit report either favorably or
           unfavorably according to each creditor’s policies with respect to the Debt
           Management Plan and Client’s payment history prior to and during participation in
           the Debt Management Plan.


__________ F. Charges:
           With respect to additional creditor charges and the duration of the Debt
           Management Plan Client acknowledges that estimated finance charges, fees or
           penalties imposed by creditors may increase Client’s overall indebtedness and the
           length of time required to fully pay Client’s creditor over and above the estimates
           provided by the Agency.


__________ G. Duration:
           The Agency estimates that Client’s Debt Management Plan shall have duration of
           __________ months. The actual duration of the Debt Management Plan will
           depend upon creditor concessions and Client’s payment history.


__________ H. Termination of Agreement:
           1. The Agency may discontinue the Debt Management Plan if Client fails to
              make consecutive monthly payments in full. Clients requesting to reenter the
              Debt Management Program are required to take CREDIT WHEN CREDIT IS
              DUE, a financial education program at a cost of $50.00.

              2. The Agency may terminate this Agreement if it finds that Client has provided
                 false information to the Agency or id Client fails to comply with any other
                 provisions, terms or conditions of this Agreement.

              3. Client may terminate this Agreement for any reason by providing ten (10)
                 days’ prior written notice to the Agency.

              4. If this Agreement is terminated by either party, Client agrees that any money
                 remaining in Client’s account shall be paid to Client’s creditors, unless
                 otherwise required by law.

              5. Client acknowledges that Client’s creditors voluntarily cooperate with the
                 Agency in agreeing to honor this Debt Management Plan. Client
                 acknowledges that if Client misses one or more deposits or makes partial
                 deposits, or for any reason deemed appropriate, Client’s creditors have the
                 right to discontinue concessions made to Client under the Debt Management
                 Plan with respect to interest, penalties and fees.
__________ I. Miscellaneous Provisions
           1. All counselors are certified credit counselors following NFCC requirements.

              2. The Agency agrees to send Client annual Statements of payments made
                 through the Agency. Clients shall monitor Client’s statements from creditors
                 to verify that payments have been received and to notify the Agency of
                 significant differences between the balances on creditor statements and the
                 Agency statements. Client may review Client’s file in the presence of an
                 Agency staff member during regular business hours.

              3. The Agency will not provide legal advice. If Client needs legal advice, Client
                 shall seek appropriate assistance.

              4. Authorized staff of the Agency or staff agencies with legitimate authority to
                 monitor practices of the Agency may review Client’s file for quality assurance
                 or compliance purposes. The finding of such review shall remain confidential.

              5. Client hereby agrees to defend, indemnify and hold the Agency , its
                 employees, officers, directors and agents harmless from any claim, suit, action
                 or demand made by any of Client’s creditors and any other person in which in
                 any manner may arise from any action or inaction taken by the Agency, or
                 Client’s creditors in connection with any services rendered by the Agency for
                 Client.

              6. Use of the singular term “Client” shall also mean plural “Clients” where
                 appropriate.

__________ J. Usage of Credit
           Client hereby certifies that all of Client’s credit cards have either been returned to
           the respective creditor, destroyed or turned into the Agency for disposal. Client
           voluntarily agrees that no further charges shall be made on the accounts. In the
           event that an account has no balance, Client shall request that the creditor close
           the account. Client shall not apply for, nor ask anyone for, more credit or assume
           any new debts without prior approval of the Agency.

__________ K. Acknowledgment:
           Client hereby acknowledges that Client has read, understands, and initialed each
           of the above provisions, terms and conditions of this agreement.

              Both the Agency and Client have received a copy of this Agreement. The Agency
              and Client agree that there are no other agreements, promises, or representations,
              unless executed in writing between the Agency and Client other than those
              contained in this agreement.
                                          CONSUMER CREDIT COUNSELING OF
                                          NORTH CENTRAL WEST VIRGINIA

                                          BY: _________________________________
                                              A: Counselor

STATE OF WEST VIRGINIA
COUNTY OF ____________________, TO-WIT:

               I, ______________________________, a notary public of said county, do certify
that ______________________________, an authorized agent of Consumer Credit Counseling
Service of North Central West Virginia whose name is signed to the writing hereto annexed,
bearing date as of the _____day of _______________, 20___, has this day acknowledged the
same before me in my said county to be the true act of said agency.
               Given under my hand this _____ day of _______________, 20___.
               My commission expires: _________________________________.

                                                  ____________________________________
                                                  Notary Public

(SEAL)

                                                  CLIENT SIGNATURE

                                                  ____________________________________

                                                  ____________________________________
                                                  (Printed Name)

                                                  CLIENT SIGNATURE

                                                  ____________________________________

                                                  ____________________________________
                                                  (Printed Name)




                          (PLEASE NOTARIZE ON NEXT PAGE)
STATE OF WEST VIRGINIA

COUNTY OF _____________________, TO-WIT:

               I, ______________________________, a notary public of said county, do certify
that ______________________________, who signed the writing hereto annexed, bearing date
as of the _____ day of _______________, 20___, has this day acknowledged the same before
me in my said county.
               Given under my hand this _____ day of _______________, 20___.
               My commission expires: _________________________________.

                                                  ____________________________________
                                                  Notary Public

(SEAL)




STATE OF WEST VIRGINIA

COUNTY OF _____________________, TO-WIT:

               I, ______________________________, a notary public of said county, do certify
that ______________________________, who signed the writing hereto annexed, bearing date
as of the _____ day of _______________, 20___, has this day acknowledged the same before
me in my said county.
               Given under my hand this _____ day of _______________, 20___.
               My commission expires: _________________________________.

                                                  ____________________________________
                                                  Notary Public

(SEAL)




                                                                Revised 11/03

				
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