CCCSSF: Balance Update Form

Balance Update Form

Use this secure form to update the balances of your accounts listed on the Debt Management Plan (DMP).

Please provide the following information from your most recent creditor statements. If you notice any Late or Over the Limit fees being charged or the proposed APR is not been reduced, please do not list that account below, but rather mail or fax us that statement so that we may follow up with your creditors to correct any errors. All other accounts should be listed below.

Creditor name
Account Number = Last 4 digits of your account number
Balance = The most up to date and correct balance available
Date = Closing date printed on creditor statement
APR = Annual Percentage Rate listed on your statement
Finance Charges = Finance charges accrued in last billing cycle

Client #

First Name

Last Name

	Creditor Name	Account Number	Balance	Date	APR	Finance Charges
1
2
3
4
5
6
7
8

If you have more than 8 accounts listed on the DMP, please submit an additional form. Please allow 5 business days for processing.

By submitting this information, I confirm that I am the person named above.