Credit Repair Intake Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail Address

example@example.com

Home or Work Number

Cellular Number

Social Security Number

Credit Services Agreement

This agreement between Juris Firm Chartered and the undersigned client is for the express limited purpose of credit verification audits. The attorney will attempt the removal of errors, misrepresentations, or unverifiable information, that the client claims appears on the credit reports that he/she has furnished the Law Firm. This is not a debt consolidation or bill repayment program. Federal law requires that unverifiable, outdated or erroneous information must be removed regardless of accuracy. The attorney agrees to act diligently in the pursuit of this legal matter and will carry out this agreement within all Federal and State laws.

Monthly Credit Restoration Services

The initial term of this agreement shall be for one year. If the client decides to cancel the monthly Credit Verification Audit at any time during the year, a written request must be sent to the Law Firm. If the attorney has worked on your file prior to receiving your written cancellation, you will be charged for the current month and then cancelled. If you do not cancel, the attorney will automatically renew this agreement for an additional year if the Credit Verification Audit has not been completed. As may be appropriate, the attorney will terminate the audit procedure if he concludes that no further work is necessary.

Service Fees

The client understands that there will not be any attorney fee charged for the credit verification audit services until after the monthly Credit Verification Audit is performed. The initial charge of $129.99 will be charged for the initial consultation and document preparation. The client understands and agrees that on the same day of every month, he/she will be charged a monthly service fee of $149.99 for all costs and fees associated with the previous month’s Credit Verification Audit. The attorney agrees to perform the service for this amount and states that there are no additional costs. Client has five (5) days to deliver the necessary documentation to the Law Firm and register for a credit monitoring service or otherwise provide access to credit files to the Law Firm. The client understands that the monthly Credit Verification Audit includes the evaluation of Equifax, Experian, and Trans Union credit bureau reports and all correspondence associated with the verification process. The client understands that there are other additional consumer reporting companies. If the client elects to have other consumer reporting companies evaluated, there will be additional monthly service fees.

Client Updates

The client agrees to send all correspondence and credit reports from the credit reporting agencies to Juris Credit as soon as received and not to send any correspondence back to the credit reporting agencies. The client must notify the Law Firm if he/she has not received any credit reports or correspondence within 40 days after the last correspondence from the Law Firm or the credit reporting agencies. The client must also inform the Law Firm of any change of address or any other status affecting the client. The client agrees to maintain a compatible active credit monitoring service at his/her expense. Failure to do so will cause the client’s last challenge of his/her Credit Verification Audit to be continued on a repetitive basis. No guarantees are implied or suggested and no oral representations shall be effective. Based upon the nature of this legal service, I understand that individuals that assist the attorney in this matter may view my file and its contents. All staff, such as legal or research assistants and secretaries, have been alerted to the sensitivity of these documents. The attorney and his staff will take all reasonable measures to ensure that this information will be handled in a reasonable manner, but are not responsible for any data breaches that may occur. You may cancel this contract, without any penalty or obligation, at any time before midnight of the 5th day which begins after the date the contract is signed by you. To cancel this contract, mail or deliver a signed, dated copy of the cancellation notice, or any other written notice to Juris Firm Chartered at 1005 W. State Road 84, Suite 472, Ft. Lauderdale, FL 33315 before midnight of the fifth day. See the attached Notice of Cancellation form for an explanation of this right.

Initial Term

The initial term of this agreement shall be for one year. If the client decides to cancel the monthly Credit Verification Audit at any time during the year, a written request must be sent to the Law Firm. If the attorney has worked on your file prior to receiving your written cancellation, you will be charged for the current month and then cancelled. If you do not cancel, the attorney will automatically renew this agreement for an additional year if the Credit Verification Audit has not been completed. As may be appropriate, the attorney will terminate the audit procedure if he concludes that no further work is necessary.

Signature*

By signing this services retainer agreement, the client hereby understands and agrees to the terms and conditions of this agreement for credit improvement services.

Signing Date

MonthDayYear

Please upload driver's license, social security card or other document reflecting social security number and utility bill or other document with proof of address.

Service Retainer Agreement