Information
Worksheet
Your First Step Toward Being
Debt Free!
You may complete the form on the screen and
then print it; or print it first and complete it in ink.
Please be careful to fill the form out
completely and include all account numbers. Make an extra copy for your records.
You may return the completed form to Consumer
Credit Counseling Service by fax, in person or by mail.
Fax Number: 541-267-7044
Address:
CCCS of Coos-Curry, 375 S. 4th Street, Suite 100
Coos Bay, OR 97420
Upon receipt of your completed
forms, one of our Certified Consumer Credit Counselors will call you to review the information and explain the
details of our services. We will also schedule a convenient time for you to meet with a
counselor or arrange to have a counselor call you and complete the session by phone.
For Printable Form- Go Here
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