Development Request:

Formulas for Debt Settlement Program:

Please complete this form detailing all the fees and charges of your debt settlement program. Use the comments section of each fee to describe special conditions like "applies from month 1 to 3", "apply after month 12", etc.

Once the formulas are developed, you will receive an email to the address entered here with the instructions about how to import them into your program.

*Company:

*Your name:

*Your Email:

Phone:

*Program Name:

This fee is usually around 15% of the Total Customer's Debt; it is charged during the first months of the program.

How much is it?

 %

This includes fees charged by the ACH Processing Company to setup the special purpose accounts.

Amount?

This fee usually starts at around $200 and it is charged 100% in the first month.

Amount?

This fee usually starts at around $45, it is charged monthly along the entire program.

Amount?

This includes fees charged by the ACH Processing Company on a monthly basis to process ACH Transactions.

Amount?

Explain here if you charge other fees. For each one indicate:

• How do you calculate it

• Beginning month

• Duration (in months).

* Field is required.