Financial Discount Agreement

Financial Discount Agreement
Name Partner #1

First Name Last Name
Name Partner #2

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
To help in meeting your financial obligations, The Northampton Center for Couples Therapy has agreed to the following payment arragement:
I,Client Name(s) , agree to adhere to the following financial guidelines, which will become effective on Date .
Signature Partner #1

Clear
Signature Partner #2

Clear
Should be Empty: