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[For use with Maine Consumers]
SAMPLE CONTRACT BETWEEN CONSUMER AND DEBT MANAGEMENT SERVICE PROVIDER
A. 1. Name and address of consumer: __________________________________________
_______________________________________________________________________
2. Name and address of debt management service provider: ______________________
_______________________________________________________________________
3. State registration number of debt management service provider: ________________
_______________________________________________________________________
B. 1. Full description of the services to be performed for the consumer: _______________
_______________________________________________________________________
_______________________________________________________________________
2. Description and amounts of any fees to be charged to the consumer: _____________
_______________________________________________________________________
3. Description and amounts of any other contributions, fees or charges the consumer has
agreed to make or pay to the debt management service provider: __________________
_______________________________________________________________________
_______________________________________________________________________
C. 1. _____________________________________________, the debt management service
provider, has posted a surety bond with the State of Maine.
2. If you (the consumer) have any questions or complaints about the business practices of
the debt management service provider, or if you wish to make a claim against the surety
bond, please contact:
Superintendent, Bureau of Consumer Credit Protection
35 State House Station
Augusta, Maine 04333-0035
In-state consumer line: 1-800-332-8529
(1-800-Debt Law)
FAX (207)582-7699
Website and e-mail access: http://www.credit.maine.gov
Debt Management Sample Contract
Page Two
D. The name and address of the financial institution where funds remitted by the consumer
for payment to creditors will be held in an escrow account is: ______________________
________________________________________________________________________
________________________________________________________________________
E. Either party may cancel this agreement at any time by providing written notice of
cancellation to the other party.
F. Attached to this agreement (see “Schedule A”) is a complete list of the consumer’s
obligations (debts) that are subject to the agreement, together with the names and
addresses of the creditors to whom those obligations are owed.
G. Attached to this agreement (see “Schedule B”) is a full description and schedule of the
periodic payment to be made by the consumer, and the amounts to be remitted to each
creditor.
H. By signing this agreement, you (the consumer) agree that state financial regulators
may audit deposits into, and disbursements from, the trust account referred to in
Paragraph D, above, to verify that the debt management service provider is complying with Maine law.
I. NOTICE TO CONSUMER: Do not sign this agreement before you read it. You must
be given a copy of this agreement.
Dated: ____________________ __________________________________
Consumer
Dated: ____________________ __________________________________
Authorized representative of
debt management service provider
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Names and Addresses of Creditors |
Amounts Owed |
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1. ____________________________________________ shall make the following payment
(Consumer’s Name)
to the debt management service provider: $______________
on the following schedule: ________________________ (weekly, bi- weekly, monthly, etc.).
***************************
2. The debt management service provider shall make payments to the creditors on the following
schedule:
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