Statement Inquiry

PLEASE READ CAREFULLY.

"This form should only be submitted after
the Negotiation Process with your
creditors is complete"

During the initial 30-day negotiation period, we sent your creditors proposals. This form should be submitted only after the negotiation process is complete. It's important to check your statements each month after negotiations are completed to ensure payments are posting with your creditors. It may take up to 3 months for some creditors to re-age your accounts and show benefits. You may receive calls from collectors or receive past due notices until your account is brought current. If correct benefits are not being given after 3 months, complete the bottom section of this form immediately. If you are unsure when benefits should start showing on your statements, call Customer Care at 1-800-390-7245. If you're being charged late fees after your account has been brought current, it may be necessary for you to contact your creditor to adjust your due date. Please call your Customer Care representative at the above numbers to get more information on how to do this.

REMINDER: EARLY, LATE OR MISSED PAYMENTS can cause problems with your creditors. Please make payments on or just before your due date each month.


Client Name:
Client #:
Date:
Home Phone:
Work Phone:
Best Time to Contact:
E-Mail:
*If your creditors are not sending statements, please call to get current account information from them. Request that they send monthly statements to you.
Creditor #1
Creditor:
Lat 4 digits of Acct #:
Phone#:
Type of Problem: Check all that apply	Late Fee Incorrect APR Missing Payment Creditor Calling (date )
Current Statement Info
Due Date:
Amount Past Due:	$
APR:	%
Finance Charge:	$
Comments:
Creditor #2
Creditor:
Lat 4 digits of Acct #:
Phone#:
Type of Problem: Check all that apply	Late Fee Incorrect APR Missing Payment Creditor Calling (date )
Current Statement Info
Due Date:
Amount Past Due:	$
APR:	%
Finance Charge:	$
Comments: