DEBT MANAGEMENT COORDINATION AGREEMENT
This Agreement by and between Cornerstone Financial Counselors, a Florida Non-Profit Community Service,
located at 10621 N. Kendall Drive, Suite 113, Miami, Florida 33176, hereafter referred as “CFC” and:
Client(s):
, hereafter referred to as “Client”
Address:
City/State/Zip:
Purpose: Client acknowledges that CFC is a financial counseling ministry that is assisting
Client to develop a long range financial strategy. In conjunction with the provision of this service, Client
has requested CFC to connect him/her to a qualified Debt Management Program (DMP) processing agency which CFC
hereby agrees to do. Client acknowledges that CFC is providing a valuable service and is entitled to receive
the compensation called for in this Agreement.
Fees: Client agrees to pay CFC a Program Coordination Fee of $
per month for the entire term of the DMP in payment
for the service of connecting Client to the DMP processing agency, for development of a long-term Personal
Financial Analysis (PFA) and for ongoing credit counseling services including special financial education,
budgeting assistance and the local administrative coordination of Client’s DMP. Failure to make such monthly
payments on time shall constitute a breach of this Agreement and shall entitle CFC to seek appropriate legal
remedy.
Client also agrees to pay CFC a one-time start up charge of $150.00 consisting of two parts: 1) a $50.00
Entry Fee refundable upon successful completion of the DMP; and 2) a voluntary $100.00 prepayment of the
monthly Coordination Fees. In exchange for this prepayment, CFC agrees to forgive the final 12 scheduled
monthly payments of the Coordination Fee.
By arrangement Client shall pay no fees to the DMP processing agency for their services.
Duties and Obligations: Client must provide CFC with a true and complete list of secured
and unsecured creditors, monthly income and expense information and any other requested information as needed
for completion of enrollment into the DMP. Client must provide statements for each creditor to be included in
the DMP. All statements must be no more than 60 days old. Client must also provide current personal contact
information including mailing address and telephone numbers. Client must be easily contactable by telephone.
CFC will not transfer Client’s file to the DMP processing agency until all requested information has been
provided. Any misrepresentation or failure by Client to provide requested information in the manner
stipulated herein may result in breach of this Agreement and the forfeiture of fees paid to date.
Term: The term of this Agreement shall endure for the same period as the term of Client’s
DMP. CFC acknowledges that if Client makes an early termination of the DMP for any reason, any remaining
balance owed to CFC under this Agreement shall be forgiven as of the date of termination of the DMP.
Hold Harmless: Client agrees to hold CFC harmless for any damages, late fees, fines,
claims, suits, garnishments, liens, repossessions, encumbrances and like matters arising out of this
Agreement whether initiated by Client’s creditors or others. Client agrees that CFC shall not be
responsible for the past, present or future credit rating of Client or for related actions arising there
from. Client understands and acknowledges that accounts in the DMP may fall past due during the enrollment
process in which event CFC shall not be held responsible.
Refunds and Cancellations: The Entry Fee of $50.00 is refundable upon successful completion
of the DMP. Eligibility requires Client to make all DMP payments on time and in full. Also, Client is required
to make any lump sum or unscheduled payments to the DMP Processing Office instead of directly to creditors.
Client shall not be entitled to a refund of either the Entry Fee of $50.00 or the prepaid Coordination Fee of
$100.00 if Client decides not to pursue the DMP after the enrollment process has been started. Nevertheless,
Client shall be entitled to a full refund of all payments in the event the DMP processing agency declines to
accept Client’s case.
Special Disclosures: Client specifically acknowledges having read and understood the
following: 1) payments due to creditors prior to the first DMP disbursement are Client’s responsibility;
2) enrollment in the DMP may have a derogatory effect on Client’s credit bureau reports and related resolution
is Client’s responsibility; 3) some creditors may require that past due amounts be paid off outside of the DMP;
4) some creditors may continue to charge over-limit fees until the account is either brought current or under
the credit limit; 5) some creditors require up to 4 consecutive on-time DMP payments before extending final
DMP approval during which time late fees and derogatory reporting may continue; 6) past due accounts could be
sent to “collection” during the time between the enrollment date and the first DMP disbursement date; 7) Client
is hereby instructed to contact their creditors and reschedule due dates where necessary to avoid late fees
because of variation with the DMP disbursement cycle.
Privacy: Client authorizes CFC to share any personal and private information with the
DMP processing agency pursuant to the administration of Client’s program.
Jurisdiction: This Agreement shall be covered by, construed and enforced in accordance
with the laws of the State of Florida without regard to principals of conflicts of law.
Signatures by Facsimile and Electronic Transmission: The parties acknowledge that
submissions of this form electronically have the same legal effect as signing or faxing this document with
signatures. Client acknowledges further that he/she has fully read, understands and agrees to the terms of
this Agreement or has consulted an Attorney where necessary before signing.
Automatic Debit: Client authorizes CFC and any and all assigns to process debit entries
to Client’s checking or savings bank account for the payment of all fees and payments called for in this
Agreement until such time as Client shall provide reasonable notification in writing to terminate the
authorization. It is understood that such authorization may not be terminated prior to termination of the
DMP except in connection with the special discount on the monthly Coordination Fee. Client is responsible to
advise CFC in writing of any change in bank information that is relevant to fulfilling the terms of this
Agreement. Client agrees to pay a handling charge of $30.00 for each uncompleted payment for the cause of
insufficient funds including electronic transfers, personal checks, etc. Current Debit information is as
follows:
In witness hereof, the Parties have affixed below their binding signatures.
For electronic Transfer, click the box if your intention is to
provide a legally binding signature by the typing of your name in the space below. You may also provide a
physical signature for facsimile transmission.
