Dominion Financial Management, Inc. Services Agreement and Disclosures

I agree to participate in Dominion Financial Management, Inc.’s coaching, education and counseling programs to help me accomplish my financial and/or housing goals. As appropriate, I will receive a written Action Plan consisting of recommendations for handling my finances, possibly including referral to other services as appropriate. I understand that:

• I also may be referred to other loan products, housing programs or services of the organization or another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me whether by Dominion Financial Management, Inc. or by another agency or agencies.

• Dominion Financial Management, Inc. cannot provide legal advice or representation nor tax advice; therefore I am responsible for obtaining such counsel should the need arise.

Conflict of Interest

Dominion Financial Management, Inc. receives funding from a variety of sources, including, but not limited to financial institutions and other industry partners, such as Fifth Third Bank, the City of Murfreesboro Community Development Department and Tennessee Housing Development Agency. I understand that I am not obligated to use the services of those institutions or partners and that the choice to enroll in such programs is voluntary. Dominion Financial Management, Inc. shall not engage in activities that create a real or apparent conflict of interest. This applies to a director, employee, officer, contractor, volunteer, spouse, child or business partner of any individual holding any of these positions.

Privacy Policy

Dominion Financial Management, Inc. is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. Your nonpublic personal information, such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your written authorization. You are automatically opted-out unless you instruct us otherwise.  We may however, use anonymous, aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs, or as required by grant awards which make our services possible.

Fees for Service

Dominion Financial Management, Inc. charges a portion of thereasonable and customary fees for coaching, education and counseling services that are not intended to create a financial hardship for those interested in our programs. Clients with an annual household income of less than 200% of the Federal Poverty Level may be eligible for a reduced fee to an amount that the client can afford to pay. This determination is made based on documentation of household income and debt obligations. Fee schedules are posted in our office and a copy is available upon request.