Payment Plan Agreement

Date:___________________

I ______________________, as client for county credit corporation do hereby agree to pay for credit counseling and financial education services as follows.

Total Due: ______________+________________/month+___________Item

Amount Paid:___________________Date:__________Balance:___________

Amount Paid:___________________Date:__________Balance:___________

Amount Paid:___________________Date:__________Balance:___________

Amount Paid:___________________Date:__________Balance:___________

Amount Paid:___________________Date:__________Balance:___________

Client Signature:__________________ Date:____________

Client Name:_____________________

File No:_________________________