Credit Repair Service Enrollment Form Individual Plan – $49.99 per month 1 Personal Information2 Payment Information3 Legal Agreements What is your Goal?*Example: Buy a House, Refinance, 640 FICO, etc...)Your Name* First Last Your Email* Your Phone Number*Your Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Monthly Service Fee Price: $49.99 Credit Card MasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name Is the Billing Address for this card the same as your home address?*YesNoBilling Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Referral CodeCongratulations! You received $10 off your first month of service. Your first payment will be only: $39.99Couples Discount Rate Applied. Your monthly fee will be: $40.00Your credit consultant will be: Michael AbramskyCongratulations! You received $10 off your service fee. Your monthly service fee will be only: $39.99 /month. Federal Disclosure* Accept Federal Disclosure StatementConsumer Credit File Rights Under State and Federal Law You have a right to dispute inaccurate information in your credit report by contacting the credit bureau directly. However, neither you nor any ''credit repair'' company or credit repair organization has the right to have accurate, current, and verifiable information removed from your credit report. The credit bureau must remove accurate, negative information from your report only if it is over 7 years old. Bankruptcy information can be reported for 10 years. 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'. AZ, AR, DE(1), IN, IL(5), MA, MD, MO, NB, OK, OR, NH, PA(5), TX(5), WA, UT: Regarding Credit Bureaus: (1) The credit bureau must provide a complete and accurate statement of the consumer's right to review any file, as reported in the Fair Credit Reporting Act (15 USC § 1681 et seq); (2) the credit bureau must provide a statement that a review at no charge will be conducted on the consumer's credit report from which a credit denial is based if requested within thirty (30) days of the consumer receiving a notice of credit denial; (3) the credit bureau must provide the approximate price the consumer will be charged for a copy of his or her credit report; (4) the credit bureau must provide a complete and accurate statement of the consumer's right to dispute the completeness and accuracy of any item contained in any file on the consumer maintained by the credit bureau; Regarding Credit Services Organizations and CreditFirm.net: (5) CreditFirm.net provides a complete and detailed description of the services performed and the total fees charged by CreditFirm.net within the Credit Report Audit Verification, Service Agreement accompanying this disclosure statement, and by this reference, made a part of this Disclosure Statement. CA, IN(4), KS(4), LA(4), MO(4), NB(4), WV(4): Regarding Credit Bureaus: (1) You may be charged a reasonable fee not exceeding eight dollars ($8) for a credit report; Regarding Credit Services Organizations and CreditFirm.net: (2) Neither you nor any credit services organization has the right to have accurate, current, and verifiable information removed from your credit report; (2) If for any reason, you cancel the Service Agreement with the credit services organization within the three days from the date you signed the Service Agreement, you do not owe any money; (3) You have a right to sue a credit services organization if it misleads you; (4) You have the right to obtain the services of a nonprofit credit counseling service which may be able to assist you in your credit matters. CO: Regarding Credit Bureaus: (1) Even when a debt has been completely repaid, your credit report can reflect that the debt was paid late if that is accurate. FL, KS, MD, MO, NB, and WV: Regarding Credit Services Organization and CreditFirm.net: Accurate information cannot be permanently removed from the files of a credit bureau. IL, KS, MD, MA: Regarding Credit Bureaus: You have the right to review your credit report at no charge if a request is made to the credit bureau within thirty days after receipt by you of notice that credit has been denied. If such request is not made within the allotted time, the credit bureau must provide the approximate charge to you for a copy of your credit report for your review (For MD residents, a maximum fee of $5 may be charged). NY: Regarding Credit Bureaus: If reinvestigation of your report by the credit bureau does not resolve the dispute to your satisfaction, you may enter a statement of one hundred words or less in your file, explaining why you think the record is inaccurate. The credit bureau must include your statement about disputed data - or a coded version of it - with any reports it issues about you. New York law also provides that, at your request, the credit bureau must notify any person who has received a report in the previous year that an error existed and furnish such person with the corrected information. TIME LIMITS ON ADVERSE DATA: Most kinds of information in your file may be reported for a period of seven years. If you have declared personal bankruptcy, however, that fact may be reported for ten years. After seven or ten years, the information can't be disclosed by a credit bureau unless you are being investigated for a credit application of $50,000 or more, for an application to purchase life insurance of $50,000 or more, or for employment at an annual salary of $25,000 or more.State and Federal Cancellation Forms* Accept Notice of CancellationNotice of Cancellation You may cancel this agreement, without any penalty or obligation, within five days after the date the agreement is signed. If you cancel, any payment made by you, under this agreement, will be returned within 10 days after the date of receipt by CreditFirm.net of your cancellation notice. To cancel this contract, mail or deliver a signed, dated copy of this cancellation notice, or other written notice to: CreditFirm.net at 1020 Milwaukee Ave, Suite 122, Deerfield, IL 60015, not later than midnight of the fifth business day after the agreement was signed. I hereby cancel this transaction. ___________________________ Signature ___________________________ Date Notice of Cancellation You may cancel this agreement, without any penalty or obligation, within five days after the date the agreement is signed. If you cancel, any payment made by you, under this agreement, will be returned within 10 days after the date of receipt by CreditFirm.net of your cancellation notice. To cancel this contract, mail or deliver a signed, dated copy of this cancellation notice, or other written notice to: CreditFirm.net at 1020 Milwaukee Ave, Suite 122, Deerfield, IL 60015, not later than midnight of the fifth business day after the agreement was signed. I hereby cancel this transaction. ___________________________ Signature ___________________________ DateCredit Repair Agreement* Accept Credit Repair AgreementA - This agreement between Confident Corp D/b/a CreditFirm.net (COMPANY) and the undersigned (CLIENT) is for the express purpose of credit report intervention. COMPANY will attempt the removal of errors, misrepresentations, or unverifiable information that the client claims to appear on the credit report(s) they have furnished COMPANY. This is not a debt consolidation or bill payment program. Federal law requires that any unverifiable, outdated or erroneous information must be removed, regardless of accuracy. COMPANY agrees to act diligently in the pursuit of this matter, and will carry out this agreement within all Federal and States laws. Company reserves the right to withdraw from representing you if you breach this Contract or for any reason permitted under applicable professional rules of conduct. In the event Company withdraws, you agree to pay Company for the services rendered previous to the date of withdrawal. B - The client understands that there will not be any fee or other charges associated with the service until after the service is performed. Company performs one or more of the following services before you pay: enters your personal data into its secure database; enters one or more credit reports into its secure database; collects information and instructions from you regarding your particular circumstances and how you wish to proceed; analyzes your case; prepares and sends one or more Communications on your behalf. Subsequently, Company typically performs one or more of the following ongoing and periodic services as appropriate in its judgment and discretion: receives and reviews Bureau and Furnisher correspondence sent to us directly or by you; collects and reviews updated information and instructions from you regarding your circumstances, goals, and case; monitors and analyzes your case; provides you with status updates regarding your case; and prepares and sends one or more additional Communications on your behalf. Fees are collected on a periodic basis, but only for services previously provided. Because fees are charged after rendering services, fees are generally not refundable. A First Work Fee of $49.99 is charged five days from the date of this Contract. This fee will be charged after related services have been fully rendered. When you elect to continue our services, you will be charged $49.99 at the end of each service interval, for work previously and fully rendered. Charges will be processed on or about the same day of each month for each service interval until you elect to suspend or cancel service. C - The client agrees to send all correspondence and credit reports to COMPANY, as soon as received. The client must notify COMPANY if they have not received any credit reports or correspondence from the credit reporting agencies 40 days after the last correspondence from COMPANY or the credit reporting agencies. Failure to do so will cause the client's Credit Verification to be delayed. D - Term of this agreement shall be: Month to Month/ Cancel any time. You are advised to review your case at least each month and determine whether you wish to continue Company’s services or suspend or cancel them. E - Due to the nature of this credit service, client understands that individuals that assist COMPANY in this matter may view client's file and its contents. All people such as legal or research assistants and secretaries have been alerted to the sensitivity of these documents. COMPANY'S staff will take all reasonable measures to ensure that this information will be handled in a responsible manner. F - I, the undersigned client, give Power of Attorney to COMPANY, for the sole purpose of acquiring, request typing verification, and disputing any information in regards to my credit report(s). By signing this document, I acknowledge receiving my "Consumer Credit File Rights Under State & Federal Law, and my agreement cancellation form. G - Client has executed a power of attorney to COMPANY to create and sign correspondence on Client’s behalf to communicate Client’s claims of inaccurate, untimely or unverifiable information to the credit bureaus. COMPANY provides an audit verification letter writing service which Challenges negative items on Client’s's credit reports. Client Understands and agrees that COMPANY does not guarantee that any verified accurate item can or will be removed from Client’s credit report. Client understands and agrees that dispute letters drafted, signed and mailed on your behalf and/or in your name by COMPANY are proprietary to COMPANY and will not be kept as part of your client file and will not be disclosed to Client. Company representatives may have discuss your case with you and in doing so may provide their opinions regarding your options as well as possible outcomes, given the information you provide to Company. Any expressions of opinion are not a guarantee and may not reflect an actual outcome. Arbitration. All claims and disputes arising under or relating to this Agreement are to be settled by binding arbitration in the state of Illinois or another location mutually agreeable to the parties. The arbitration shall be conducted on a confidential basis pursuant to the Commercial Arbitration Rules of the American Arbitration Association. Any decision or award as a result of any such arbitration proceeding shall be in writing and shall provide an explanation for all conclusions of law and fact and shall include the assessment of costs, expenses, and reasonable attorneys' fees. Any such arbitration shall be conducted by an arbitrator experienced in Credit Repair and shall include a written record of the arbitration hearing. The parties reserve the right to object to any individual who shall be employed by or affiliated with a competing organization or entity. BILLING DISPUTES – CHARGEBACKS Do not contact your bank or Credit Card Company in an attempt to obtain a refund. While your bank or credit card company may provide a temporary 'provisional credit' of the disputed amount, please be advised that COMPANY is successful in reversing the vast majority of chargebacks. In addition to the original charge, you accept responsibility for fees associated with the processing and follow up of the dispute. These costs range from $50.00 to $150.00. COMPANY reserves the right to collect these fees via the original payment method or through third party collection. COMPANY strives to exceed member expectation and provide Outstanding Customer Service. If you feel you are entitled to a full or partial please contact COMPANY for details regarding our Refund Policies and Procedures. 1-800-750-1416 Mon - Fri 9:00 am through 7:00 pm (CST) Digital SignatureE-sign grants electronic signatures and documents equivalent legal status as traditional handwritten signatures. By completing our Enrollment you are digitally agreeing to The Service Agreement and you are certifying that your digital signature is the equivalent of your handwritten signature. Furthermore, you agree that you have read all of the Terms and Conditions and the Agreement and are signing each section of the Agreement with your digital signature. You further agree that you understand the Agreement and have read "Your Rights as a Consumer".Your Social Security Number*Your Date of Birth*Your Signature*Please type your signature This iframe contains the logic required to handle Ajax powered Gravity Forms.