Credit Repair Intake Form
Type the name of the person doing your Credit Repair.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Please Upload current Utility Bill
*
Browse Files
Drag and drop files here
Choose a file
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of
Please Upload Drivers License
*
Browse Files
Drag and drop files here
Choose a file
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Please Upload Social Security Card
Browse Files
Drag and drop files here
Choose a file
Cancel
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Credit Monitoring Required – Minimum 90 Days I understand that credit repair and credit monitoring work together. I agree to purchase and keep active credit monitoring for at least 90 days so my credit file can be reviewed and disputes can be prepared. If I do not purchase or maintain credit monitoring for the required time, I understand that services cannot be completed as intended and no refunds will be issued.
*
Please Acknowledge
Signature Acknowledging you read and understand the terms and conditions of this credit monitoring agreement.
My Products
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CR
$299.00
$
299.00
Quantity
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Payment Methods
Credit Card
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
Submit
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