I understand the agency will provide a confidential comprehensive personal money management interview.

I understand that the interview will be conducted by a certified consumer credit counselor or qualified professional counselor. All action plans, not conducted by a certified consumer credit counselor, will be reviewed by a certified consumer credit counselor.

I understand that in the event we are dissatisfied, I can utilize the Complaint Resolution Process.

I understand that most of the agency funding comes from voluntary contributions from creditors who participate in Debt Management Plans (DMP). Since creditors have a financial interest in getting paid, most are willing to make a contribution to help fund our agency. These contributions are usually calculated as a percentage of payments you make through your DMP - up to fifteen percent (15%) of each payment received. However, your accounts with your creditors will always be credited with one hundred percent (100%) of the amount you pay through us and we will work with all your creditors regardless of whether they contribute to our agency.

I hold the agency, its employees, agents and volunteers harmless from any claim, suit, action or demand of my creditors, myself or any other person resulting from advice or counseling. This provision shall not apply to actions or claims under the provisions of the United States Bankruptcy Code, 11 U.S.C. Sec. 101 et seq.

I will be given a written assessment outlining a suggested client action plan which will be based on the following options:

1. I will handle my financial concerns on my own.
2. I may choose to enroll in the agency's Debt Management Plan. Our DMP's serve the dual role of helping you repay your debts and helping creditors to receive the money owed to them. The agency has no responsibility or obligation for any past, present or future credit rating I receive. In certain circumstances, a Debt Management Plan may effect my credit rating negatively. In the event that the counselor suggests a Debt Management Plan, I will receive complete details of the operations, requirements, and responsibilities.
3. A counselor may answer questions about bankruptcy, but not give legal advice. If I want legal advice, I will be referred for appropriate assistance. While an attorney can make a recommendation to file bankruptcy, it is a personal choice based on individual circumstances. I will inform the agency of the decision if I file bankruptcy.
4. I will be referred to the other services of the organization or another agency or agencies as appropriate that may be able to assist with particular problems that have been identified.

At sometime in the future, my information may be used for confidential research and / or a neutral third party may contact me to request an evaluation of the agency's services.