• REBORN Financial & Business Services

    Credit Conseling Client Enrollment & Agreement Packet

  • Client Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.

  • Package Selection

  • CLIENT COMMUNICATION PREFERENCES

  • Package Selection*
  • Preferred Contact Time*
  • Essential Package

  • Alternate Contact

  • Plus Package

  • CREDIT PROFILE & GOALS

  • Main credit concerns*
  • Have you reviewed your current credit reports?
  • Which credit bureaus do you want reviewed?

  • Credit-Service Intake

  • Format: (000) 000-0000.
  • Credit concerns*
  • May REBORN contact this alternate contact regarding your account?

  • GET YOUR CREDIT SCORE NOW

  • CREDIT MONITORING / MY FREE SCORE NOW

  • Do you already have the active MYFREESCORENOW/CREDIT MONITORING account on our site?*

  • Please click link to sign up!!

    https://app.myfreescorenow.com/enroll/B01C6231
    https://app.myfreescorenow.com/enroll/B02C6231

  • Use this link to access your credit-monitoring/score service as directed by REBORN. Complete enrollment only if instructed or applicable to your selected service.
  • REBORN Financial & Business Services does not control MyFreeScoreNow's pricing, membership, trial, cancellation, privacy, or other terms. Review the provider's terms before enrolling.

  • CREDIT REPORT & SUPPORTING DOCUMENTS

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  • REQUIRED CLIENT DOCUMENT UPLOADS

  • Please upload clear, readable documents that belong to you. Use this secure form only—do not send these documents by ordinary email or text.
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  • Upload File
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  • Upload File
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  • Client Responsibilities Acknowledgements

  • Agreement and Disclosure Acknowledgement

  • Important Notice
  • Acknowledgement of Current Agreement and Disclosures*
  • Texas Credit-Services Disclosure*
  • Consumer Credit File Rights Disclosure*
  • Compliance Note

  • Cancellation Acknowledgement

  • Cancellation Notice
  • You understand that you should not send original court documents or collection notices to us. Only send copies of documents that will support your case (i.e. proof of payment, court dismissal documents, etc.). We are not acting as your legal guardian in any way and it is your responsibility to seek outside legal assistance if the need ever arises for an Attorney needed to protect your rights.
  • Do you understand and agree that you should only send copies of supporting documents, not original court documents or collection notices, and that you are responsible for seeking outside legal assistance when needed?*
  • Do you understand that we do not keep copies of all of the paperwork you forward to us, and that it is your responsibility to keep copies of any paperwork you may want to reference at a later date?*

  • CREDIT REPAIR ORGANIZATIONS ACT

  • SEC. 405. DISCLOSURES
    (a) Disclosure Required. Any credit repair organization shall provide any consumer with the following written statement before any contract or agreement between the consumer and the credit repair organization is executed:
    Consumer Credit File Rights under State and Federal Law
     


    You have a right to obtain a copy of your credit report from a credit bureau. You may be charged a reasonable fee. There is no fee, however, if you have been turned down for credit, employment, insurance, or a rental dwelling because of information in your credit report within the preceding 60 days. The credit bureau must provide someone to help you interpret the information in your credit file. You are entitled to receive a free copy of your credit report if you are unemployed and intend to apply for employment in the next 60 days, if you are a recipient of public welfare assistance, or if you have reason to believe that there is inaccurate information in your credit report due to fraud.


    You have a right to sue a credit repair organization that violates the Credit Repair Organization Act. This law prohibits deceptive practices by credit repair organizations. You have the right to cancel your contract with any credit repair organization for any reason within 3 business days from the date you signed it.


    Credit bureaus are required to follow reasonable procedures to ensure that the information they report is accurate. However, mistakes may occur.


    You may, on your own, notify a credit bureau in writing that you dispute the accuracy of information in your credit file. The credit bureau must then reinvestigate and modify or remove inaccurate or incomplete information. The credit bureau may not charge any fee for this service. Any pertinent information and copies of all documents you have concerning an error should be given to the credit bureau.


    If the credit bureau's reinvestigation does not resolve the dispute to your satisfaction, you may send a brief statement to the credit bureau, to be kept in your file, explaining why you think the record is inaccurate. The credit bureau must include a summary of your statement about disputed information with any report it issues about you. The Federal Trade Commission regulates credit bureaus and credit repair organizations. For more information contact: The Public Reference Branch Federal Trade Commission Washington, D.C. 20580'.

  • CLIENT SERVICE AGREEMENT & PACKAGE CONFIRMATION

  • Selected Package Confirmation*
  • The exact services to be provided are governed by the written agreement and service/pricing schedule.
  • No specific credit score increase or removal of accurate, current information is guaranteed.

  • CLIENT AUTHORIZATION & CONSENT

  • I confirm that the information I provided to REBORN is truthful and complete to the best of my knowledge.*
  • I authorize REBORN to perform only the services selected in my written agreement.*
  • I understand that REBORN does not guarantee a specific credit-score increase or the removal of accurate, current information.*
  • I confirm that documents I submit belong to me and are authentic and unaltered.*
  • I authorize REBORN to communicate with me using the contact method(s) I selected in this form.*
  • I understand that my electronic signature and date constitute my acknowledgment of the selections and certifications I make in this enrollment form.*
  • Signature Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Signature Section

  • Signature Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Client Confirmation*

  • Internal Use Only

  • Contract Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Manager Approval*
  • Should be Empty: