P24 Client Enrollment

Full Name *

First Name Last Name

Birth Date *

Month Day Year

Social Security Number *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

E-mail *

Total Due *

Individual Enrollment/Audit Fee - Credit Repair $ 197.00

Monthly payments will be $97/month due every 30 days until the client gets the credit scores they desire

Couple Monthly Enrollment - Credit Repair $ 247.00

$247 enrollment and then $147 monthly

Journey to Home Program $ 600.00

This is a 6 month program. We will build, repair, and guide you in establishing credit and good financial habits.

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Do you currently have life insurance for you, your spouse, and/or dependents? *

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Are you interested in a FREE life insurance quote? *

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By signing below:

I authorize Power of 24 Financial to regularly charge my card on the amount indicated in this form on a regular basis, $97 monthly for an individual OR $147 monthly for couples and shall remain in effect until I request for the cancellation or termination.

Cancellation Policy: Services are provided on a month-to-month basis and clients may cancel their service at any time at least (30) thirty days in advance of any upcoming recurring payment. When canceled according to these terms, the upcoming recurring payment will constitute the final payment due for services rendered. All services are billed in arrears.

I certify that I am the authorized user of the Credit Card that shall be submitted through this form. As long as the transactions correspond to the terms and conditions indicated in this authorization, I shall not raise disputes against the company.

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