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  • 1
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  • 2
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  • 3
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  • 4
    Please visit www.experian.com to confirm
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  • 5
    Please visit www.experian.com to confirm
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  • 6
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  • 7
    Experian is the preferred score if unavailable you may upload your score from a different source but you will be required to create an Experian account
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    Max. file size: 10.6MB
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  • 8
    Choose any that apply
    Please Select
    • 1. Remove Late Payments
    • 2. Dispute Incorrect Items (e.g., collections, charge-offs)
    • 3. Remove Hard Inquiries
    • 4. Remove Judgments or Liens
    • 5. Bankruptcy Removal
    • 6. Remove Foreclosures
    • 7. Increase Credit Limit
    • 8. Remove Repossession
    • 9. Identity Theft/Fraud Resolution
    • 10. Credit Counseling
    • 11. Debt Negotiation/Settlement
    • 12. Student Loan Correction
    • 13. Credit Report Monitoring
    • 14. Build Positive Credit History
    • 15. Other (please specify)
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  • 9
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  • 10
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  • 11
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  • 12
    Drivers License, State Identification Card, Passport,
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  • 13
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  • 14
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  • 16
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 17
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  • 18
    Utility bill, insurance, etc
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  • 19

    Consent & Agreement:

     


    1. Terms & Conditions Agreement

    • “I have read and agree to the terms and conditions of Lockhart Connected’s credit repair services. I understand that these services are intended to assist with improving my credit but do not guarantee a specific outcome.”

    2. Authorization for Credit Access

    • “I hereby authorize Lockhart Connected to access my credit reports from the three major credit reporting agencies (Equifax, TransUnion, and Experian) for the purpose of evaluating and improving my credit profile.”

    • “I understand that this authorization will remain in effect until the credit repair process is complete or until I revoke it in writing.”

    3. Identity Verification

    • “I verify that the information provided in this form is accurate and complete to the best of my knowledge. I understand that providing false or misleading information may result in the termination of services.”

    4. Refund Policy Acknowledgment

    • “I acknowledge that I have reviewed and understand the refund policy for credit repair services. I understand that fees paid for services rendered may not be refundable unless otherwise specified in the terms and conditions.”

    5. Electronic Signature Agreement

    • “By signing below, I consent to the use of electronic signatures for this agreement. I understand that my electronic signature is legally binding and holds the same authority as a handwritten signature.”

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