$175 Special New Client Intake Form
Please enter your information as accurately as possible. Please UPLOAD your REQUIRED DOCUMENTS.
Name
*
First Name
Last Name
Birthdate
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email address
*
Phone Number
*
Please enter a valid phone number.
Upload Front and Back of Government Issued Drivers License or ID card.
*
Browse Files
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of
Upload a CURRENT BILL within 30 days with your name and current address.
*
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Cancel
of
Please give a brief description about your credit concerns., and your expectations from our service.
*
Please verify that you are human
*
PAYMENT
*
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( X )
BASIC PLAN
$
497.00
Quantity
1
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GOLD PLAN
$
697.00
Quantity
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PLATINUM PLAN
$
897.00
Quantity
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MONTH-TO -MONTH
250.00 INITIAL FEE
$
250.00
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EVICTIONS
$
200.00
Quantity
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REPOSSESSION
$
200.00
Quantity
1
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STUDENT LOAN
$
350.00
Quantity
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TRADELINE
$
450.00
Quantity
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LATE PAYMENT
$
75.00
Quantity
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Flash Sale 7-Day Results
$
300.00
Quantity
1
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Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
Date
*
-
Month
-
Day
Year
Date
Signature
*
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