Consumer Credit Counseling Official On-Line Support Site
24 hours a day 7 days a week
(A Credit Counselor will be assigned to you immediately to help you get started!)
Consumer Credit Counseling's On Line Secure Application Form


National Consumer Credit Counseling Agency

TOLL FREE: (877) 426-6363
info@-credit-counseling.org

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

Complete this form for your Free No Obligation quote, then use the "Submit Now" button to send the Application Form to AMMEND Credit Counseling.  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 Budget Information

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
Spouse's Employer
Job Title

CREDITOR LISTING SHEET  (PLEASE MAKE SURE YOUR INFORMATION IS ACCURATE!)
Creditor Account# (No Spaces or Dashes!) 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 , 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.

info@-credit-counseling.org

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