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Supplemental Counseling Agreement for Pre-Filing Counseling

BALANCE has over 40 years of experience in helping people with financial problems. We will conduct a budget analysis that will examine your financial situation, discuss the factors that may be the cause of your problems, and explore your options for developing a reasonable plan for dealing with them.

We will provide you with information about bankruptcy, including the process and possible consequences. We will also discuss alternatives to bankruptcy. At the conclusion of this session, you will be promptly provided with a certificate that you will need should you decide to file for bankruptcy. The certificate is valid for up to 180 days after the counseling session is completed. The certificate will be provided only to clients who complete counseling.

While our counselors have expertise in helping those with financial problems, we cannot provide you with legal advice. This session is designed to provide you with information and alternatives; it is not intended to take the place of a consultation with an attorney to explore your legal rights and options.

In order for us to assist you, it is essential that you provide us with information that is as accurate and complete as possible. For that reason, we may ask you to authorize us to access your credit history. All information concerning your financial condition and status is strictly confidential. Such information may include, but is not limited to: income, debts, credit accounts, earnings, assets, and employment data. We will not disclose any such information that you provide orally or in writing to anyone, except as authorized by you in writing or as required by law, or by the Executive Office of US Trustees. We may compile data and aggregate information that you give us, but this information will not be disclosed in any manner that would personally identify you. BALANCE will not disclose or provide any information about this session to a credit reporting agency, so there will be no impact on your credit report or score for obtaining credit counseling. If you should decide to enter into a Debt Management Plan (“DMP”) you will be provided with separate agreement and disclosure forms. Participation in a DMP may affect your credit report and credit score, and could have a negative impact on a credit worthiness decision by a potential creditor, landlord or employer in the future.

The fee for pre-filing counseling is $50 per individual (or per couple, if counseled together). Payment is due at the time of the counseling session, and can be made via money order or cashier's check, or we can electronically debit your checking account (please have a check available to provide us the account and routing information). If you are unable to pay, you may have your fee waived. If your household earnings are less than 150% of the federally determined poverty level for your state and family size, your fee will be waived. No additional fees will be charged for the generation of certificates.

BALANCE is a member of the National Foundation for Credit Counseling (“NFCC”) The NFCC has high standards for quality credit counseling and financial education, and we comply with those standards.Our counselors have been granted the Certified Consumer Credit Counseling designation by the National Foundation for Credit Counseling. Each has completed an extensive in-house training program on all elements of personal finance and counseling skills.

BALANCE is accredited by the Council on Accreditation (“COA”) – an independent third-party organization that reviews and monitors entities that provide social services.

BALANCE is a non-profit agency. We are organized and operate in accordance with Section 501(c)(3) of the Internal Revenue Code.

BALANCE primarily receives funding in the form of grants and contributions. A significant portion of funding comes from voluntary contributions from creditors who participate in DMPs. Since creditors have a financial interest in having debts repaid, most are willing to make a contribution to help fund the overall services of this agency. These contributions are usually calculated as a percentage of payments that are made through a DMP.

For clients with limited English proficiency, our services are available online and via telephone in Spanish. For speakers of other languages, we will provide service via telephone with the assistance of Language Line translation services at no additional charge.

Our policy prohibits us from paying or receiving referral fees for the referral of clients, except under a fair share agreement.

The EOUST has approved our organization to provide the required counseling for bankruptcy filing. They have not reviewed other services of our organization.

We offer a Debt Management Plan, which may be an option for you to use to repay your unsecured debts.

I have read and understand the disclosures made above.

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