Contribution

Community Credit Counseling Specialists
"Your COMMUNITY Credit Counseling Service."
A Non-Profit Community Service
Helping Consumers Become Debt-Free Since 1982

Contribution
Automated with ACH

Member Of American Association Of Debt Management Organizations

We Are ISO 9000 Quality Certified
ISO 9001:2000
FS59499

INSURED
AND
BONDED

Credit Counseling Contribution

There are no charges or fees for budget and debt counseling. If a debt repayment plan is developed and administered by Community Credit Counseling Specialists, a donation is requested to help defray administrative costs. Such donations are not mandatory by the client, and services will be provided regardless of the clients ability to pay such donations.

Voluntary contributions are also provided from many of the credit grantors who participate in our program. Most of the major credit grantors provide voluntary funding to enable the services of Credit Counseling to be available to the community.

Community Credit Counseling Specialists Inc. is designated by the IRS as a 501 [c] [3] charitable organization and is also recognized by the State of Ohio as a tax-exempt, non-profit corporation.

Our counselor will consult with you on an appropriate donation based on your counseling program plan.

Payments will be withdrawn from your bank checking or savings account automatically on the scheduled payment
date set up when you joined our Debt Management Program. Barring complications, electronic payment will begin
within thirty (30) days following receipt of this authorization form. ANY CHANGES TO THIS WITHDRAWAL
SCHEDULE MUST BE REQUESTED AT LEAST TEN (10) WORKING DAYS PRIOR TO THE SCHEDULED
WITHDRAWAL DATE AND MUST BE MADE IN WRITING.

If there are not sufficient funds in your account to complete the withdrawal, there will be a $20 fee assessed to
cover our bank charges.

To contribute directly from your bank account please complete this form:

Client Number:
Name as it appears on your check:
Address:
City:	County:
State:	Zip:
Your Telephone Number:
Your Email:

Withdrawal Amount Approved:
Routing Number: (9 digits only beginning with 0,1,2 or 3)	See check picture below for example
Account Number:
Bank Name:
Bank's Phone Number:


By submitting this form you authorize Community Credit Counseling Specialists to process this ACH transaction.

If you wish to contribute by mail order or cashier's check, mail to us at this address:
Community Credit Counseling Specialists, Inc.
5301 Southwyck Blvd., Suite 100
Toledo, Ohio 43614-1580
Telephone 419-865-2333
Toll Free 1-888-662-3313
Fax 419-868-0207
E-mail