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Client(s) understands and agrees they have enrolled in the Debt Management Program (DMP) through Pioneer Credit Counseling (PCC) 1644 Concourse Drive, Rapid City, SD 57703, a 501(c)(3) non-profit, bonded, consumer credit counseling and educational agency, and client(s) hereby authorizes PCC to receive any information regarding client(s) accounts and/or creditors. Client(s) agrees to pay a Commitment fee equal to $ (not to exceed $50). Client(s) hereby authorizes creditors to send any additional information needed to PCC. This release agreement for information on my account may be copied and the copy of the signature may be deemed to be equivalent to the original and may be used as a duplicate original. Client(s) understands the original will be stored in laserfiche.

1. * PCC will act upon the information received by client(s) in client(s) best interest. PCC will use discretion when disclosing any information or amount of income, living expenses and debt as necessary when negotiating with client(s) creditors. Should client(s) default on payment to the DMP, the rights and interest of client(s) creditors will not be jeopardized.

2. * In order for client(s) debt to be repaid as quickly as possible, client(s) requests that all creditors waive or reduce finance charges/interest rates and fees wherever possible if allowed in their companies' policies for DMP's. Client(s) understands once PCC has sent initial inquiry letters, client(s) creditors may continue to contact client(s) personally. It is client(s) responsibility to pleasantly discuss their accounts with them. Client(s) will encourage creditor who calls to contact PCC at 605-348-1608. However, if the creditor is unwilling to contact PCC, it is client(s) responsibility to notify PCC of the name and phone number of creditor to whom called. Client is also responsible for calling PCC with any questions on statements received from creditors. PCC can make no guarantees of creditor policies or time of concessions.

3. * PCC does not guarantee that collection efforts, legal action, judgments, or garnishments will not be entered against client(s) for any creditor listed on DMP.

4. * Client(s) understands PCC is a non-profit third party administrator and is not representing itself as a loan company or insurance company. Client(s) also understands that no promise, warranty, or guarantee has or will be made on the part of PCC to clear client(s) of any debts or make client(s) payment(s) on client(s) behalf. Client(s) understand that by enrolling in the DMP with PCC, client(s) credit report may reflect a consumer credit counseling status and in some cases may cause a negative effect on client(s) credit report. PCC cannot repair or prevent any ratings that may appear on my credit report past, present, or future. Client(s) hereby authorizes PCC to obtain client(s) credit report solely for the purpose of Consumer Credit Counseling when needed by applicable creditors and in order to meet their proposal requirements. Client(s) understand(s) this will appear as an inquiry on their credit report.

5. * Client(s) understands he/she must disclose to PCC all credit accounts. Client(s) wishes not to charge any further goods or services until my debts are paid in full. Client(s) hereby attests to the fact they have personally destroyed all charge card(s) and any accompanying cash-advance checks and request that my creditors close my charge accounts until further notice. Failure to comply with this agreement could result in cancellation of the DMP.

6. * Client(s) understands they are responsible for their debts and when client makes monthly deposit client(s) agree that creditors will be receiving payments on client(s) behalf through the PCC Client Trust Account (held at BankWest, maintained and managed by PCC). Client(s) first payment is due on or before 30 days after the date of client(s) enrollment. PCC will contact client(s) regarding scheduled monthly payment and payment due date to PCC in Rapid City, SD. If, for any reason, client(s) payment will not be received at PCC office by the scheduled due date, client(s) will contact PCC to inform us of the situation. PCC disburses to all creditors no later than 15 days from receipt of valid funds or as scheduled. When necessary, client will maintain payments to creditors during initial process.

7. * Client(s) understands it is their responsibility in making payments on time. If client(s) does not make payments for two consecutive months, and does not communicate with PCC's phone calls or letters, a letter will be sent to client(s) creditors stating client(s) has defaulted on the DMP.Client(s) understands the following communication methods will be used by PCC; US Mail, E-mail, Telephone and Text Messaging.

8. * Client(s) understands that due to regulations governing PCC's Trust Account, client(s) scheduled payment must be in one of the following forms of payment: money order, cashier's check, checking debit card, western union, automatic payment from checking/savings. Client(s) will include client number, name, address, phone number on any payment sent. PCC will not be held liable for late fees or other service charges caused by posting payment to wrong client(s) account due to client(s) failure to identify form of payment.

9. * Client(s) authorizes any bank in which Pioneer Credit Counseling or its agent has established a trust account to disclose to the Administrator any financial records relating to the trust.

10. * Pioneer Credit Counseling will comply with its accounting obligations under section 12-14.5-227(a). PCC will provide the client with an activity statement which details the amounts received from the client, the amounts disbursed to their creditors, any funds being held for future disbursement, and any fees deducted from the payment since their last statement. An activity statement is provided: 1) Before and upon cancellation or termination of any agreement, 2) after each disbursement to the client's creditors, 3) within 5 days of a clients request, 4) no less than monthly. Also, PCC will contact the client in regards to any less than full balance settlements offered by the creditor. PCC will contact the client via telephone, e-mail, or US Mail with the terms and amounts involved in the settlement.

11. * Client(s) understands when extra income is available to apply to debts, client(s) shall direct PCC where to apply the extra funds, however, PCC may have final discretion on disbursement of funds to debts and the application of all client funds will be disclosed to the client on the current Monthly Activity Report.

12. * PCC is a nonprofit agency and receives support from voluntary contributions. Most of our funding comes from voluntary contributions made by creditors who participate in DMP's. Creditors help PCC with contributions to continue the educational programs offered by PCC.

13. * Pioneer Credit Counseling will notify the client (s) within five days after learning of a creditor's decision to reject or withdraw from a plan, the identity of the creditor and the right of the client(s) to modify or terminate the agreement.

14. * Pioneer Credit Counseling believes that the following creditors will not participate in the plan and to which PCC will not direct payment:

15. * Pioneer Credit Counseling will provide with this agreement a copy of your "Repayment Schedule" which will include: the amounted owed to each creditor, the amount of each payment to each creditor, any concession PCC reasonably believes each creditor will offer, the date on which each payment is due, and an estimate of the date of the final payment.

16. * Client(s) understands by paying a monthly counseling fee, which is included in scheduled monthly payment to creditors and is equal to $ (not to exceed the lesser of $50 or $10 per creditor) will make available to them the following benefits: 800 number available, on-going consultations with Certified Counselors for review of debts, educational material pertaining to basic credit and budgeting, consulting with client(s) creditors and arrange for new payment plan, requesting creditors to re-age client(s) account, following up with creditor correspondence sent to client(s). Client(s) understands that fees are nonrefundable.

17. * Nothing herein shall apply to actions or claims under the provisions of the United State Bankruptcy Code, 11 U.S.C. § 101 et seq.

18. * Client(s) may contact the Office of the Attorney General, Debt Management (UCCC), 1525 Sherman St., 7th Fl., Denver, CO 80203, Phone (303) 866-4494, email, web site with any questions or complaints regarding Pioneer Credit Counseling.

19. * Client(s) may cancel the agreement at any time, without penalty or obligation, by giving Pioneer Credit Counseling written or electronic notice, in which event: - Pioneer Credit Counseling will refund all unexpended money that PCC or its agent has received from the individual for the reduction or satisfaction of the client(s) debt; - All powers of attorney granted by the individual to PCC are revoked and ineffective;

20. * Pioneer Credit Counseling may terminate the agreement for good cause, upon return of unexpended money of the client(s)

IMPORTANT INFORMATION FOR YOU TO CONSIDER - Debt-Management Plans are not right for all individuals, and you may ask us to provide information about other ways, including bankruptcy, to deal with your debts. - Using a Debt-Management Plan may hurt your credit rating or scores - We may receive compensation for our services from your creditors.

NOTICE OF RIGHT TO CANCEL You may cancel this agreement, without any penalty or obligation, at any time before midnight of the third business day that begins the day after you agree to it by electronic communication or by signing it. To cancel this agreement during this period, send an e-mail to or mail or deliver a signed, dated copy of this notice, or any other written notice to Pioneer Credit Counseling at PO Box 6860 Rapid City, SD 57701 before midnight on ___________. If you cancel this agreement within the 3-day period, we will refund all money you already have paid us. You also may terminate this agreement at any later time, but we are not required to refund fees you have paid us.

If client(s) wishes to cancel, PCC must receive request in writing.

* By checking this box and entering my full name in the box below, I(we) have read and understand the DMP Agreement and agree to all of the terms and conditions stated above and by entering my full name I am signing this document and the signature may be deemed to be equivalent to the original.

*Primary Applicant Electronic Signature (Please enter your full name)

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