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Credit Repair & Tradeline Application
Please fill out the following information. Your information is secured and encrypted on our internal server. It's an easy to fill form and mobile responsive.
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1
Name
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First Name
Middle Name
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2
Date of Birth
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Date
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Address
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Street Address
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Afghanistan
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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
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Botswana
Brazil
Brunei
Bulgaria
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Canada
Cape Verde
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China
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Colombia
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Cook Islands
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Cote d'Ivoire
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Cuba
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Malaysia
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Mali
Malta
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Martinique
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Mexico
Micronesia
Moldova
Monaco
Mongolia
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Montserrat
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Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
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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
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
Country
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4
Social Security Number
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5
** VERY IMPORTANT!
Create an account at
www.experian.com
and provide the username. Please purchase all 3 bureaus at
www.experian.com
. Please set the password to "Credit123". (All lower case except the "C" in credit, no caps no spaces.) Also set your security pin to "0000" and your security question to "0000". You can find this under "My Profile / Sign in and Security tab"..............This is needed for us to monitor and access your credit reports.
Username:
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6
** VERY IMPORTANT! Create an account at
www.creditkarma.com
and provide the username. Please set the password as "Credit123". (All lower case except the "C" in credit, no caps no spaces.) This is needed for us to monitor and access your credit reports.
Username:
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7
Please upload a current screenshot of your creditkarma .com credit scores and Experian.com credit scores
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Max. file size
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8
Upload a photo of the front and back of your valid drivers license.
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Make sure to upload both sides of your ID.
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9
Mobile Phone Number
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(###) ###-####
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10
E-mail
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11
What package have you selected?
Pro
The Max
Tradelines
Pro
The Max
Tradelines
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12
What are your present Credit Score?
Equifax
Transunion
Experian
Score
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Score
Equifax
Row 0, Column 0
Transunion
Row 0, Column 1
Experian
Row 0, Column 2
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13
What is your realistic targeted credit score with our firm?
Target Credit Score
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14
Are you interested in our business funding program?
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Yes
No
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15
Please briefly describe what are you goals with your new and improved credit scores?
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16
Upload a photo of a recent utility bill within the last 2 months that clearly shows your name and address. (ex. electricity bill, bank statement or phone bill )
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17
Do you believe you were the victim of identity fraud or Equifax's recent breach? Do you have accounts or inquires that you don't recognize?
YES
NO
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18
Digital Signature Date
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Date
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Day
Year
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19
Term – The term of this Agreement is three (3) months from its execution and all services must be performed during that period. The Agreement may be extended for an additional three (3) month period by an amendment to this Agreement. Guarantee – Although we cannot guarantee by law a certain outcome, we prepare documents conforming to Federal Law, certain state Privacy Laws, and the Fair Credit Reporting Act. We will prepare documents to assist you to accurately report to the credit bureaus and place a fraud alert on your file to assist in protecting you against future data breaches and attempts to use your identity in a fraudulent manner. Governing Law – This Agreement and any dispute arising from the performance or breach hereof will be governed by and construed and enforced in accordance with the laws of the State of Florida, without reference to the conflicts of laws principles of any jurisdiction. Entire Agreement – This Agreement, including any attachments to the Agreement, sets forth the entire Agreement regarding the subject matter of the Agreement, and supersedes and terminates all prior agreements and understandings between You and MAXTAX ACCOUNTING LLC. No subsequent alteration, amendment, change or addition to this Agreement will be binding upon You and Us unless reduced to writing and signed by You and Us. Non-Profit Credit Counseling Services – You have the right to hire a non-profit credit counseling service. Customer Responsibilities and Communications – You agree to assist us in answering certain security questions regarding your identity and credit history as may be necessary to obtain your credit reports. Staffing– MAXTAX ACCOUNTING LLC may assign clerical staff, or others to perform work on your case. You agree services in connection with our representation of you may be performed by any associate of MAXTAX ACCOUNTING LLC You may revoke your Limited Power of Attorney by filling out and signing the Revocation of Limited Power of Attorney form attached to this Agreement as Attachment 2.' Your Right to Cancel Agreement – You may cancel this contract without penalty or obligation at any time before midnight of the third day after the date on which you signed the contract. See the attached notice of cancellation form for an explanation of this right.
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20
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