Verifying a Creditor



Please fill out this form as completely as possible with your company’s guidelines for working with Credit Counseling agencies. You may send this worksheet back to us by Fax: 617-564-9304 or mail it to: ACCC, Attention: Creditor Update, 130 Rumford Ave. Suite 202, Auburndale, MA 02466. If you have any questions, please call Mary-Jo at 800-769-3571 Ext. 5770.Creditor Name:Escalated Issues: Name: Phone #: E-Mail:Daily Issues: Name: Phone #:CCS pymt Address or RPPS Biller ID#:CCS Proposal Addressor RPPS Biller ID#:Billing Address (for Fair Share Bills if applicable) AGENCY GUIDELINES CLIENT BENEFITS on programFair Share Contribution: % NoneFixed Program Interest Rate: %No ReductionFair Share Payment Method:Bill DeductIf not Fixed, Variable Rate Info:Accept Batch Checks?YesNoMinimum Payment Percent Required?_____% of Balance or _____% of reg. monthly payment. Return Proposals?YesNoProposal Return Method:RPPS Mail FAXMinimum payment amount accepted?$Do you require LPOA w/ proposal Yes No Stop Late Fees while on DMP? Yes NoAccept FAX Proposals? Yes NoStop Overlimit Fees While on DMP?YesNoFAX #:Will Recall Account from Collections?YesNoAccept Call To Action Proposals? Yes NoCan Client Change Due Date?YesNoStd pmt %____ APR____ Hardship pmt % ____APR___Reage Accounts? YesNoAccept Less Than Full Balance? Yes NoAfter 1 2 3 Consecutive payments (Circle One)Minimum % of balance you will accept __________%Client will be dropped after ______ missed payments. Can client reapply for DMP? Hardship Policy: ................
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