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Client(s) understands and agrees they have enrolled in the Debt Management Program (DMP) through Black Hills Children's Ranch, Inc. d/b/a Pioneer Credit Counseling (hereinafter referred to as PCC), 1644 Concourse Drive, Rapid City, SD 57703, (800)888-1596, FAX (605)348-8537, 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. The DMP is for people that are experiencing financial difficulties or will soon fall behind. Under this program creditors often reduce or eliminate the interest in order to help you get out of debt. Many creditors will also reduce or completely eliminate late fees and bring your account current, even if you are now behind. PCC will receive a lump sum payment from you each month and PCC will pay your creditors based on the arrangements established with them until your account is paid in full. As your smaller debts are paid, a higher percentage of your payment will go towards your larger debts.

Client(s) agrees to pay a Consultation Fee equal to $(not to exceed $75). 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 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 and will monitor statements monthly to ensure proper concessions. 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. 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 client(s) 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 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 client(s) 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 client(s) creditors close client(s) 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) and client(s) also authorize this financial institution to disclose to the Kansas State Bank Commissioner any financial records relating to client(s) during the course of any investigation. 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 each week onThursday and the last business day of each month. 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, 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.

9. * 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.

10. * PCC is a nonprofit agency and is compensated from the consumer's creditors in the form of 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.

11. * Client(s) understands by paying a monthly counseling fee, which is included in the scheduled monthly payment and is the lesser of $5 per creditor per month or a maximum of $40 per month, which is equal to $, will make available to them the following benefits and provide the following services: 800 number available, on-going consultations with Certified Counselors for review of debts and budget, 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). PCC will not require a voluntary contribution from client(s) for any services provided. Client(s) understands that fees are nonrefundable.

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

13. * Client(s) agrees that any dispute between us that cannot be amicably resolved, and all claims or controversies arising out of this agreement, shall be settled solely and exclusively by bind arbitration according to the Federal Arbitration Act (9 U.S.C.A. § § 1 et seq.).

14. * Client(s) understands that PCC will not require client(s) to buy any other product or service as a condition of entering into the debt management services agreement nor attempt to solicit or offer to sell any other product or service during the debt management services agreement.

15. * The Kansas Office of the State Bank Commissioner will accept questions and complaints from consumers regarding BHCR, Inc. d/b/a Pioneer Credit Counseling (Registration #CSO.0000002) at 700 SW Jackson, Suite 300, Topeka, Kansas, 66603, or by calling toll-free 1-877-387-8523.

16. * I (we) testify that the information provided by me (us) is truthful and correct. I have read, understand and agree with all of the conditions of the Debt Management Program.

The client(s) may cancel at any time; PCC must receive a request to cancel from the client(s).

* 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)

Spouse Electronic Signature (Please enter your full name)

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