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:_________________________
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