CLIENT ACTION LIST

Please complete all information on this checklist and fax back to the fax number circled
below. Please include all information asked for on this checklist to ensure quick processing
into the program.

CLIENT NAME: _Joseph Clancy___

FEDRAL DEBT RESOLUTION REPRESENTATIVE: Patrick Culhane

TEL: 877-375-7045 x 302 FAX: 866-945-9585 Email: PCulhane@fdrhelp.com

Personal Information Sheet:(Pages 2)

Make sure all information is provided, including:

q Social Security Number (s)

q Date(s) of Birth
q Sign and Date

Client Service Agreement: (Pages 3-5)

q Initial page 3
q Initial page 4
q Sign and date page 5

Monthly Fee Schedule of Deposits: (Page 6)

q Program deposits to be debited from your home town bank to your new account. This form
separates your fee from what we ESTIMATE will be used to settle your debts.

Client Accounts: (Page 7)

In order to expedite the processing, we need ALL of the following information for every
account in the program. (Expect delays in processing beyond 72 hours on ALL accounts if any
creditor account information is missing.)
q Clearly print Creditor Account Information for each corresponding debt in the space provided
Sign where indicated. Both signatures are required if spouse is included

Noteworld New Account Set- up (Attached)

q Fill out all information

q Initial page 1
q Sign and date page 2
q Make a COPY of a Voided Check and Enclose it with the above. (Please make
sure that all of the numbers, Name and Address are legible.)

Page 1
 Personal Information (Debtor #1)

First Name: _Joseph____________________ MI: ______ Last Name: _Clancy__________________________________

Current Address: _408 Lark Court Apt C_______ City: _Carmel_____ State: _IN___ Zip: _46032_________

Home Phone: _(317)569-5364__ Cell: _____________________ Work: ____________________ Fax: ____________________

Social Security Number: _312-52-3627_____ Date of Birth: _4/21/1955__________

Email: _josephclancy@att.net_________

Signature: X _________________________________________________ Date: X __________________________________

Personal Information (Debtor #2)

First Name: _______________________________ MI: ______ Last Name: ____________________________________________

Current Address: ________________________________ City: ______________________ State: ______ Zip: ________________

Home Phone: ____________________ Cell: ____________________ Work: ____________________ Fax: ____________________

Social Security Number: _____________________ Date of Birth: ________________________

Email: _______________________________________

Signature: X __________________________________________________ Date: X ______________________________________

Page 2
 CLIENT SERVICE AGREEMENT
This Agreement (hereinafter referred to as the “Agreement”), entered into this 18 day of August,
2009 between, _Joseph Clancy_ (hereinafter referred to as the “Client”) and Federal Debt Resolution
(hereinafter referred to “Provider”), and collectively referred to as the “Parties”.

Now, and for good consideration, the receipt of which is acknowledged, the Parties agree as follows:

1. Nature of Agreement. This Agreement grants Provider the authority to assist the Client resolve
debts which are owed by the Client. A separate list which is incorporated herein by reference is
attached to this agreement as Addendum 1. It is expressly acknowledged by all parties that the
Provider will not pay or directly resolve any debt owed by Client. Provider will assist Client to
develop a strategy for saving money which will then be used to negotiate a settlement on Client’s
behalf with the creditors which are listed in Addendum 1. Client understands that Provider is
expressly not giving any legal, tax or investment advice. If client wishes to seek an opinion for any
legal, tax or investment advice, then Client should consult with a certified professional in each field.
Should Client become involved in a lawsuit with any of the creditors described in Addendum 1, or
any lawsuit whatsoever, Client understands that Provider DOES NOT provide for legal representation
and that Client will have to retain their own outside counsel. It is further understood that Provider
has not made any promises to Client in regards to modification, improvement or correction of credit
entries on Clients credit reports. Client also understands that Provider has not made any promises
regarding the Provider’s ability to stop phone calls from Creditors.

2. Client Duties. Client agrees to fully disclose to Provider all responses required from Client Intake
Sheets and to be completely truthful and honest at all times with Provider. Should the address or
phone number of Client change, Client shall immediately notify Provider of change. Client agrees to
consider reasonable settlements with Creditors which have been recommended by Provider. Client
agrees to make timely payments as outlined in the Fee Schedule, “Addendum 2” (which is
incorporated into this agreement by reference) and is personally responsible for all debts. Client
understands that all debts owed by Client as outlined in Addendum 1 are the sole responsibility of
the Client. Should Client not fully cooperate with any part of the above described in Section II, it will
be considered a breach of the agreement and Provider shall have the right to cancel the contract.

3. Provider Duties. Provider will work on behalf of the Client and keep all records and agreements
confidential. Provider from time to time will have members of Provider Staff and independent
contractors assist in providing services to Client. Client hereby authorizes these disclosures which
are at the sole discretion of Provider.

4. Settlement. Client must approve all settlements and Provider will not settle any Creditor Debt
without the complete approval of the Client. Provider will send to Client all settlement offers
containing the applicable terms and conditions. Client shall notify Provider in writing to the address
below if Client wishes to accept the terms of the settlement offered by the creditor. Client shall be
responsible for making all settlement payments directly to Creditor. Any tax consequences of the
settlement of the account with Creditor is the complete responsibility of the Client and Client
understands and acknowledges that Provider has not given any tax advice regarding the settlement.
Client should consult with an accountant or attorney regarding any questions about the tax or legal
implications of settlement.

INITIAL X______ INITIAL X______

Page 3
5. Disputes. Provider does not foresee any disputes arising with Client and agrees to promptly resolve
any complaints by Client. However, should any disputes arise between the parties as a result of this
Agreement, the Parties agree to submit to binding arbitration and waive their right to a trial by jury
or judge. The Parties agree that the appropriate venue for any arbitration or any other legal
proceeding shall be Brevard County, Florida. Binding arbitration means that both parties give up the
right to a trial by jury or judge. It also means that both parties give up the right to appeal from the
arbitrators ruling except as to a narrow range of issues which that can or may be appealed under
Florida law. It also means that discovery may be severely limited by the arbitrator. Parties agree
that binding arbitration is the sole remedy which the Parties may use to settle their disputes. The
prevailing party shall be entitled to reasonable attorney’s fees and costs. In no event shall either
party be entitled to more than $1,000, of fees and costs.

6. Warranties. Client understands that Provider makes no warranties, either express or implied
regarding the services provided to client. Client understands that any opinions about possible
outcomes are mere speculation by the Provider and that upon execution of this Agreement Client
acknowledges that Provider has made no promises as to the outcome of the services. Client
understands that Provider does not have the ability to stop creditors from the following, continuing
to charge interest on the account, reporting delinquent payments to credit agencies, filing a lawsuit
to collect debt owed. Client also understands that each case is unique and that the results can vary
greatly based upon the Creditor and the Client’s ability to save sufficient funds for settlement.

7. Provider Fee. Provider charges a flat fee of 15% of the total debt for its services. Provider shall earn
1/3 of the fee when the budget review, service agreement analysis and file set up is performed;
Provider shall earn 1/3 of the fee when the initial correspondence to the creditors is prepared;
Provider shall earn 1/3 upon notice from the Client to begin settlement of the Creditor accounts.
Client understands that all fees are for the complete service that Provider is contractually obligated
to perform for Client and that the fees are not based upon individual acts or services performed by
Provider.

8. Savings. Client agrees to save funds for use to settle accounts with Creditors and to pay the
applicable fees to Provider as per this Agreement. At Clients request, Provider can supply Client with
access to an agent to assist with savings and payments related to the Agreement. Any use of these
third parties is a complete and separate Agreement between Client and the third party. Should Client
not wish to use an agent to assist with savings and payments, Client understands that Client must
make their own arrangements to account for and pay all fees and settlements directly.

9. Creditor Relationship. By entering this agreement, Client acknowledges that Provider has not
made any suggestions or taken any actions to disrupt the relationship between the Creditor and the
Client. Client represents that Provider has not made any suggestions regarding the reduction or
termination of payments to the Creditors. Client acknowledges that all actions taken and not taken
by Client in Client’s relationship with Creditors were taken independent of Provider

INITIAL X______ INITIAL X ______

Page 4
 10. Cancellation. Either party can cancel this agreement at any time by serving written notice upon the
other party at the addresses provided below. Should client cancel this agreement it is understood
that any fee earned by Provider is earned for services rendered and Client is not entitled earned fees.
Additionally, Client may cancel this Agreement before midnight of the third day after the effective
date of this agreement without any penalty or obligation.

Federal Debt Resolution

165 N Orlando Ave Suite A
Cocoa Beach, FL 32931

11. Waiver of Liability. Client expressly understands, waives, releases and discharges Provider from
any and all liability, know or unknown, from beginning of time to all times future as it related to any
and all claims whatsoever, including but not limited to any allegation of action of Provider that Client
may construe as giving legal advice. Provider is NOT a law firm and does not provide legal advice as
it’s services. Client understands that Provider is not a law firm and will not provide defense for any
litigation resulting from interaction with the creditors.

12. Complete Agreement. This Agreement and Addendums represent the complete Agreement
between the parties. Any oral representations made but not included in this agreement are NOT a
part of this Agreement.

BY SIGNING BELOW, I REPRESENT THAT I HAVE READ THIS DOCUMENT FULLY AND UNDERSTAND ALL
TERMS CONTAINED HEREIN.

_________________________________________________

Signature

_Joseph Clancy____________________________

Client Name

Page 5
Addendum 1
Monthly Fee Schedule (Add $12.50 per month for bank fee)

Months in Phase 1 Phase 2 Phase 2 Phase 3

Draft Date
Program Service Fee Service Fee Client Savings Client Savings
1 10/1/2009 $ 270.92
2 11/1/2009 $ 270.92
3 12/1/2009 $ 270.92
4 1/1/2010 $ 270.92
5 2/1/2010 $ 270.92
6 3/1/2010 $ 270.92
7 4/1/2010 $ 270.92
8 5/1/2010 $ 170.92 $ 100.00
9 6/1/2010 $ 170.92 $ 100.00
10 7/1/2010 $ 170.92 $ 100.00
11 8/1/2010 $ 170.92 $ 100.00
12 9/1/2010 $ 170.92 $ 100.00
13 10/1/2010 $ 170.92 $ 100.00
14 11/1/2010 $ 170.92 $ 100.00
15 12/1/2010 $ 170.92 $ 100.00
16 1/1/2011 $ 170.92 $ 100.00
17 2/1/2011 $ 170.92 $ 100.00
18 3/1/2011 $ 170.92 $ 100.00
19 4/1/2011 $ 170.92 $ 100.00
20 5/1/2011 $ 170.92 $ 100.00
21 6/1/2011 $ 170.92 $ 100.00
22 7/1/2011 $ 170.92 $ 100.00
23 8/1/2011 $ 136.66 $ 134.26
24 9/1/2011 $ 270.92
25 10/1/2011 $ 270.92
26 11/1/2011 $ 270.92
27 12/1/2011 $ 270.92
28 1/1/2012 $ 270.92
29 2/1/2012 $ 270.92
30 3/1/2012 $ 270.92
31 4/1/2012 $ 270.92
32 5/1/2012 $ 270.92
33 6/1/2012 $ 270.92
34 7/1/2012 $ 270.92
35 8/1/2012 $ 270.92
36 thru 60 9/1/2012 $ 270.92

Client Signature X

Co-Client Signature X

Page 6
Addendum 2

Client Name: _Joseph Clancy____

Creditor Name Account Number Balance

1. LVNV Funding GEMB/WalMart 6011 3100 0314 XXXX $ 5,453

2. CitiBank 7945 0129 0358 1 XXXX $ 4,092

3. Select Comfort/GEMB 6034 6233 XXXX $ 3,093

4. UDS Great Expectation 25XXXX $ 2,663

5. Midland Credit HSBC 852947XXXX $ 2,582

6. LVNV Funding Paypal Buyer Act/GEMB 6044 0710 0187 XXXX $ 2,581

7. Applied Bank 4227 0938 XXXX $ 1,438

8. Collection Account AT&T 1131XXXX $ 1,386

9. Capital One 4862 3622 XXXX $ 1,366

10. Portfolio RC HSBC 5488 9750 1461 XXXX $ 1,194

11. LVNV Funding GEMB/Meijer 6005 0650 0214 XXXX $ 1,183

12. LVNV Funding GEMB/Old Navy 6018 5962 2271 XXXX $ 929

13. Midland Credit Tribute Mastercard 852318XXXX $ 826

14. Arrow Financial Premier Bank 4426XXXX $ 718

15. Hamilton AC A100A1CGR1110XXXX $ 647

16. Dakota Bank 4006 1000 0346 XXXX $ 495

17.

18.

19.

20.

Client Signature: X $ 30,646

Co-Client Signature: X

Page 7