Enrollment Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Date of Birth

Last 4 of SSN

Email

example@example.com

Are you in active bankruptcy? If so contact us once completed

Have you worked with another credit restoration company within the last 6 months?

I have enrolled in the preferred credit monitoring service on website(if not please enroll before moving forward listed at the top left hand corner of website)

Please list your credit monitoring user name and password below

*needed to prepare analysis*

Signature

My Products

Collections, Medical Bills, Late Payments 6 Month Program

This program is a consultation fee that includes up to 6 rounds of disputes, portal access, and credit building tips. Enrollment in preferred credit monitoring required while in program at $24.95 per month. *Ideal for clients with less than 15 negative items reporting on credit file

$500.00

Repossession, Foreclosure, Bankruptcy 6 Month Program

This program is a one time fee consultation that includes welcome email, 5 rounds of disputes, portal access, credit analysis, and credit building tips. Enrollment in preferred credit monitoring required while in the program at $24.95 per month.

$950.00

Remove and Rebuild program 12 month Flat Rate

This program is a consultation fee that includes welcome email, unlimited disputes for up to 12 months, credit analysis, and credit building tips. Enrollment in preferred credit monitoring at $24.95 a month required while in program

$1,200.00

ChexSystems (One Time Payment)

Have you been denied a bank account? We can help!!

$275.00

Enter coupon

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Medical Personnel will receive 10% off of any program with code THANKYOU w/ valid ID (Please upload below)

Browse Files

I understand that I will be able to request a 100% refund if no results at the end of the 6 month program