:-) AMMEND.org, Non Profit Consumer Credit Counseling Agency.

On Line Application
Your New Monthly Payment will be returned to you within about "1" hour!

Simply complete this form for your Free No Obligation quote, then use the " Submit Now " button to send the Application Form to AMMEND Credit Counseling . Please note this is not a secure form. If your Browser supports "Secured" pages then Click Here to visit our Secure On-Line Form Your counselor will then email you the results within "one hour"!

Confidential Credit Counseling application form below:

.	Non Profit Consumer Credit Counseling Agency Service

.	Providing Debt Management solutions for Customers Nationwide

.	Providing solutions in the Credit Counseling Industry

. .	40,000 Creditors across the United States of whom we work with on a regular basis

.	Non profit Credit Counseling service to all Consumers

Results in "1" hour!

.	A personal credit counselor will be assigned to you directly

Complete as"John Smith" or "John and Mary Smith"
Be sure to list maiden names if they are on the accounts

First and Last Name

Address

City	State	Zip Code

Home Phone (No Dashes)	E-Mail Address

Your Employer

We do not contact your employer

- Job Title

First and Last Name

- Job Title

CREDITOR LISTING SHEET
(PLEASE MAKE SURE YOUR INFORMATION IS ACCURATE!) Please note that this form is not secure, please do not supply valuable information such as account numbers, SSN, etc. Please use our secure form here.

1	Creditor	Current Balance	Monthly Payment	What is Debt for?	# of Pmts behind (if any)
1.		$	$
2.		$	$
3.		$	$
4.		$	$
5.		$	$
6.		$	$
7.		$	$
8.		$	$
9.		$	$
10.		$	$
11.		$	$
12.		$	$
13.		$	$
14.		$	$
15.		$	$
16.		$	$
17.		$	$

Desired monthly payment date (1-21st only)

What "Keywords" did you type to find our site?

Additional Comments

How did you learn about AMMEND?

By clicking on the Submit button below, YOU UNDERSTAND: AMMEND Credit Counseling, Inc. is a Non-Profit, community service organization and that there is not charge for this service or application.

By clicking on the Submit button below, YOU AUTHORIZE: AMMEND Credit Counseling, including its employees, officers and agents to discuss any and all aspects of my financial affairs with whom they deem necessary in order to help me solve my financial problems. I agree to hold AMMEND harmless from any claim, suit, action or demand of my creditors, myself, or any other person arising out of this agreement. Any of my creditors to discuss my account with AMMEND , which includes, but is not limited to, balance information, payment history, and potential adjustments to contractual terms and conditions that the creditor may be willing to make. You also fully understand and agree to the terms and conditions listed herein.