Application for ADR Credit Restoration Program
Please accurately complete the following application to determine your eligibility for ADR Credit Repair Program and to get your personalized quote. Please note: You CAN temporarily be disqualified.
First Name
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First Name
Last Name
*
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Are you in an active bankruptcy?
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Please Select
Yes
No
Do you have negative items on your credit report? (ex:collections, charge-offs, late payments, repossessions, etc.)
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Yes
No
I am not sure
What kind of negative items do you have on your report? (select all the apply)
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Collections
Charge-offs
Repossession
Inquiries
Bankruptcy
Late Payments
Eviction
None of the above
How Many Negative Accounts Do You Have? (ex: late payments, collections, charge-offs, etc)
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I Don't Have Any Negative Accounts
1-5 Negative Accounts
6-10 Negative Accounts
10+ Negative Accounts
Are you in a financial bind that will prevent you from paying your bills on-time in the next 6 months ?
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Please Select
Yes
No
Are you prepared to invest in credit restoration? (As low as $349 down to get started.)
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Please Select
Yes
No
Not right now, but I can get the fund ASAP!
When will you have the funds to invest in credit repair ?
I don't know
Within the next 30 days
In 3-6 months
How soon are you looking to get started? Please note, that this program is for serious and goal driven individuals only.
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ASAP!
Within 2 weeks
Within 30 Days
With in 60 Days
Not sure if I am ready for change
Credit Repair requires much patience and can take up to a year for restoration. Are you willing and able to be patient and cooperate if accepted into this program ?
*
Please Select
Yes
No
We require an active subscription for credit monitoring to work on your credit. Are you willing and able to invest an additional $25/month for credit monitoring?
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Please Select
Yes
No
Why are you wanting to repair your credit? What are your credit goals.
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Submit
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