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+___________ItemAmount 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:_________________________ Download PDF Version for Printing Click and Download PDF