General Counseling Application

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Have you ever been enrolled in a Debt Management Program?
       

Do you rent or own your home?

Preferred Contact Method:
     

Reason Consumer Needs Assistance:
     
 

Referral Source:
                         

Describe Reason for Counseling:

Please enter a zero for all required items below that do not pertain to you.

Income Source Household Living Expenses
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Miscellaneous Expenses *
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Client's Preferred Method Of Payment:
     

Please enter a zero for all required items below that do not pertain to you.


*Creditor's Name Creditor's Address *Account Number *Balance Owed *Monthly Payment *Past Due Payment *% Rate Due Date

Once you complete your counseling application you will be contacted by one of Pioneer's Accredited Credit Counselors to perform a more in depth session.




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