CREDIT REPAIR SERVICE FORM

Please complete this form and submit a clear copy of your ID and utility bill (containing your contact information, mailing address and phone number) as well as your SSN. After completing this form and making payment, you will be redirected to the Identity IQ credit monitoring site to join up. Please give over your log-in details (Username and Password) once you've signed up.

Personal Information

Full Name *

Date of birth *

Phone *

Email *

Gender *

Female

Male

What are you repairing? *

Business Credit
Personal Credit
Business and Personal Credit
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Address *

City *

State *

Country *

Country

Credit Information

What are the blemishes currently on your credit?

Late Payment

Lien

Repossession

Collection

Bankruptcy

Judgement

Other

Are you having trouble qualifying for any of the following?

Auto Loans

Mortgages

Credit Cards

Jobs

Loans

Apartment/Condo

Other

Have you ever had credit repair done before? *

Yes
No
Other
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Credit Score (Current)

Additional Notes

Upload Files Here *

Submit a clear copy of your ID and utility bill (containing your contact information, mailing address and phone number) and also your SSN here.

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