DMCC: Debt Management Credit Counseling Corp.

DMP CONNECT PROGRAM

+ ONE LOWER MONTHLY PAYMENT

+ REDUCED INTEREST RATES

*First name	*Last name
*Contact Phone	Other Phone
*E-mail	* Unsecured Debt
By not consenting to receive a phone call or email, DMCC will be unable to contact you. It is suggested that you consent so that we can assist you. or call 866.314.5014 The Telephone Consumer Protection Act requires that you verify your email and telephone numbers. I consent to receive email, SMS and/or phone calls from DMCC. I understand that consent is not required to receive free information or make a purchase.

In order to submit an application for the DMP Connect Program, you need to complete the Creditor and Budget information on the following pages.