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List of Counselee Debt (Please give totals for both spouses if married.)
1. Please list all your outstanding debts whether or not you are up to date with the payments.
2. Include all unsecured debts such as credit cards, bank signature loans, consolidation loans, doctors and hospital bills, store charges, and finance company accounts.
3. Please make sure to identify which unsecured accounts you want to include on your repayment plan.
4. Please include secured debts
(home, student and auto loans etc). * Will not be included on your repayment plan.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Counselee Debt Information ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Creditor Name:                           
Phone:
 		 Address:
City:
 State:
 Zip:
Account #:

Total Owed :
 Monthly Payment:
 APR:
Pymts behind: Yes No Secured loan:YesNo Include in plan: Yes No

For CFM Use Only
# M  D  A FS: M%P: M$P: i%: Bal:$ Pymt:$
P              
$              
M
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Counselee Debt Information ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Creditor Name:                           
Phone:
 		 Address:
City:
 State:
 Zip:
Account #:

Total Owed :
 Monthly Payment:
 APR:
Pymts behind: Yes No Secured loan:YesNo Include in plan: Yes No

For CFM Use Only
# M  D  A FS: M%P: M$P: i%: Bal:$ Pymt:$
P              
$              
M
  1. After you have filled the appropriate blanks above,
  2. If you need to enter more Creditors, Click Next at top of page (after printing previously completed page).
  3. Repeat Steps 1 & 2 as needed.

  4. TO INCLUDE COPIES OF YOUR INCOME TAX RETURNS FOR THE LAST TWO YEARS, A RECENT PAY STUB, COPIES OF YOUR MOST RECENT CREDITOR STATEMENTS, AND A RECENT COPY OF YOUR CREDIT REPORT (including your FICO score), and your $287.50 Money Order Payment to

    Christian Financial Ministries (ATTTN: Financial and Life Coaching Department)
    302 Old Clay Street
    Marietta, GA 30060

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