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Bankruptcy Education Course and Certificate Enrollment Form

Welcome!

Please use the form below to enroll in our Trustee approved± Pre-Discharge Bankruptcy Debtor Education Course. This is also known as your Form 23 course, second certificate, or pre-discharge certificate.

Our Internet course is $15.00 single or joint, and our telephonic courses start at $27.00 (includes textbook, shipping and handling). There are no hidden fees for our course.

± Approved to issue certificates evidencing completion of a Personal Financial Management instructional course in compliance with the Bankruptcy Code. Approval does not endorse or assure the quality of a Provider's services.






 * required fields
** required fields for Joint users


*  I understand that a HIGH SPEED (DSL/Cable Modem) Internet connection is required.
   (Not applicable for Telephonics)
Yes     No   


Disclosures and Fee waiver Policy
READ Disclosures and Fee waiver Policy
    * Yes     No   *I have read and agree to the Disclosures and Fee waiver Policy .    

This course is for persons who have already filed for bankruptcy and need to take the second course. The accompanying certificate meets the bankruptcy court requirement for your bankruptcy discharge (finalization). When you complete this course, your Debtor Education Certificate(s) is available the same day.

±Approved to issue certificates evidencing completion of a Personal Financial Management instructional course in compliance with the Bankruptcy Code. Approval does not endorse or assure the quality of a Provider's services.

If you have not filed for bankruptcy yet, please note that this is not a Credit Counseling Course. You can find a our Credit Counseling Course at
http://www.standsurecc.org


* Please provide the following information:

* Select Course Type:

  STUDENT #1  
STUDENT #2
* First Name:  
** First Name:  
Middle Name:  
Middle Name:  
* Last Name:  
** Last Name:  
* Username:  
** Username:  
* Password:  
** Password:  
* Confirm Password:  
** Confirm Password:  
* Home Phone:  
** Home Phone:  
Work Phone:  
Work Phone:  
Cell Phone:  
Cell Phone:  
* Date of Birth:     
** Date of Birth:  
  
* SSN No. (last 4 digits):  
** SSN No. (last 4 digits):  
* Email:  
** Email:  
* Confirm Email:  
** Confirm Email:  

CASE NUMBER NOTE: Your case number is a seven digit number such as 07-12345 or 06-98765. This number is issued to you by the bankruptcy court after you have filed for bankruptcy. If you do not have a case number, contact your attorney for assistance.

Some courts have unique numbering systems.

If your case number looks like this: You should enter this:
07-XYZ-12345 07-12345
07-12345-XYZ 07-12345
3:07-5K-12345 07-12345

Entering an incorrect case number will delay receipt of your certificate.

* Bankruptcy Case Number:   -
* Judicial District:  

    Student Mailing Address (not the Bankruptcy Court address)
* Address:  
Address 2:  
* City:  
* State:  
* Zip:  

* Do you have an Attorney?   Yes   No
** the following attorney fields are required if you answered yes above.
** Attorney Name:  
** Attorney Phone Number:   --
Attorney Email:  
Attorney Firm:  
Attorney Address:  
Attorney City:  
Attorney State:  
Attorney Zip:  
  Fax a copy of my certificate to my Attorney?
Attorney Fax:   --
Attorney ID:   * 2-4 digit number. ONLY IF YOU KNOW IT.

Payment Options

If you would like to make payment arrangements via money order rather than eCheck, Credit Card or Debit Card (or if you have problems with processing your order), please contact Stand Sure Information Services, Inc. at (877) 750-0851 to speak with a customer service representative.



You are currently paying by Credit Card

Payment Information CLICK HERE if your Billing Address is the same as Mailing?
* Name on Card (First/Last):  

* Billing Address:  
Address 2:  
* City:  
* State:  
* Zip:  
* Card Type:  
* Card Number:  
(do not enter spaces)
* Expiration:   /
* Card v-code:   (3 or 4 digit number on back of card)


You are currently paying by Attorney Code

No payment information is required. Your attorney provide you with a code (if available) and will be billed for your course.


Code:

» Check Code!



You are currently paying by eCheck


* Account Owner First Name:  

* Account Owner Last Name:  
* Bank Routing Number:   [ ? ]
* Bank Account Number:   [ ? ]
* Bank Name:  


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