credit repair form

JHL FINANCIAL SERVICES ENROLLMENT FORM 800-603-1418
First Name
Last Name
Address
City
State
Zip Code
Social Security Number
Birth Date

MonthDayYear
Home Phone
Alternate Phone
Email Address
Program one time start up fee $96.00 then $96.00 per month for 5 months total $576.00- program is for 6 months - Purchasing program you agree to terms and conditions as is stated on "our cost page"
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JHL FINANCIAL SERVICES ENROLLMENT FORM 800-603-1418