Community Credit Counselors

<% Response.Buffer = true %> Community Credit Counselors

			(Feel free to use an alias, all information is strictly confidential.)
	*First Name:		Middle Name:		*Last Name:		SS Num:

*Address:

	*City:		*State:		*Zip Code:
	Home Phone:		Work Phone:		*Email Address:


	We are unable to accept tax debt payments or student loan payments. Please call the IRS or the student loan customer service number to make arrangements directly with them as they will not work with credit counseling agencies nor will they speak with anyone except the debtor.

Enter the following information from your most recent statement. If you don't have this information, call the creditor to obtain it. Please do not enter an interest rate over 23%.

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Creditor

Current
Balance

Minimum
Payment

In Collection?
No Yes

Interest
Rate
value="Interest Unknown" onClick="fillInterest<%=p%>()">

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