xxxx CC Appllication C

Appendix C: Counseling Methods and Business Locations
(Application for Approval as a Nonprofit Budget and Credit Counseling Agency)

Name of Agency:__________________________________________________________________
Counseling Methods:
In-Person:

Telephone:

Telephone/Internet:

Internet:

____Yes ____ No

____ Yes ____ No

____ Yes ____ No

____ Yes ____ No

Languages Offered:

Languages Offered:

Languages Offered:

Languages Offered:

Contact Information: (To be posted on the United States Trustee approved list)
Address:

Telephone number:

Web address:

Business Locations:
List all business locations and include telephone number and business hours. In last box,
check if In-Person counseling is available at the location.
ADDRESS
(include street, city, county and state)

TELEPHONE
NUMBER

BUSINESS
HOURS

IN-PERSON
COUNSELING
AVAILABLE

(April 2006)