County Credit

Payment Plan Agreement

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Date:___________________

I ______________________, as client for county credit corporation do hereby agree to pay for credit counseling and financial education services as follows.

Total Due: ______________+________________/month+___________Item

Amount Paid:___________________Date:__________Balance:___________

Amount Paid:___________________Date:__________Balance:___________

Amount Paid:___________________Date:__________Balance:___________

Amount Paid:___________________Date:__________Balance:___________

Amount Paid:___________________Date:__________Balance:___________

Client Signature:__________________ Date:____________

Client Name:_____________________

File No:_________________________

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