Full Credit Repair Form ONE

Credit Repair Form

Full Credit Repair Form

Fill Out The Application Below
Application Joint Application Things We Need Payment

IMPORTANT: Do not give information such as phone numbers & email addresses that you do not want us to use freely. We want to keep your information while working with us "confidential". Please make sure to fill out this form entirely using N/A for items that don't apply to you check your information carefully.
SECURITY: All information is shredded at completion of your service for extra security.
TIP: Make sure you are ready to start this service before submitting this application.


HEADING	Your Name - Address - Phone Information Please Use The Address You Get Mail At... This Is Important. P.O. Boxes are considered an address too.
*First Name
*Middle Name
*Last Name
Suffix	(Jr Sr I II III)
*Street Address
Apartment #
*City
*State
*Zip Code
*County	Country
*How Long At This Address

Home Phone	(area code) plus number
Work Phone
Cell Phone
Fax Phone
HEADING	Personal Information Section Double Check Your Numbers Please These Are Important
*Social Security	Confirm Social
*Age
*Date Of Birth Confirm Birthday
Maiden Name If applicable
HEADING	Previous Address You must fill in your previous address including zip code especially if you have not lived at your current address for over two (2) years.
Previous Address:
City:
State
Zip Code
Employer Name
HEADING	Email Addresses Don't Give Us Email Addresses You Do Not Want Us To Send Email To
*Email One
Confirm Email One

*Email Two
Confirm Email Two
HEADING	Questions To Help Us Help You Please Be Honest This Information Is Important
Do You Have one or all of your credit reports?	Sending reports helps get things moving quicker if you have them. If not, it is okay, we will obtain them.
If Yes, Can You Send them?
Do You Know Your Credit Scores
If Yes, What's Your Score
What's The Reason For Cleaning Credit
In Your Opinion How Long Will This Take
You Found Us How
Referred By Whom	If A Person Referred Give Name
HEADING	Payment Information Please read carefully You are not submitting money here
Initial Payment Paid How?
Mailing Payment? Please Read	If other, how & when Please don't continue this form if payment is not going to be made in three days. Wait until you are ready to start the service and then complete this application. Thank you
Are You A Joint or Single Account
Comments or Special Instructions?

HEADING	Terms & Conditions Client Duties You will be allowed to print these later on
Will You Agree To The Following Duties?	Client Duties: PLEASE READ 1. You must send any and all credit reports to Credit Clean when you get them. We provide envelopes to start you off. Credit reports will come to you about every 30 to 45 days. Each report omitting the first one will show changes we need to know these. 2. You must notify Credit Clean if you change address, email or phone numbers. Not a lot here that you have to do but if you don't do them then we can't help you.
Do You Agree Credit Clean Terms & Conditions	TERMS AND CONDITIONS OF CREDIT CLEAN Full Credit Repair Service Applicant(s) will here after be referred to as "Client or Client's" who have sent electronically or by a postal service the full credit repair service form and have agreed to the terms and conditions by checking the "I AGREE SECTION" of said form either electronically or physically. 1. Client Limited Power of Attorney (For The Purpose Of Credit Repair ONLY) a) Conditions of the limited power attorney and it's uses: i) This limited power of attorney is used only to help you with the repair and restoration of your credit. This does not give us full power of attorney over your affairs it's only for use with credit concerns. ii) CLIENT(s) give and appoint Credit Clean a div. of WebHead Ventures, Inc, it's officers, employees and agents, located at 532 Bridle Path Way, Tarpon Springs, Florida 34688, phone (727) 939-0311 as my assistant for my behalf, as set forth in the following matters only. iii) Signing of correspondence addressed to the credit bureaus, the signing of correspondence addressed to creditors, obtaining credit information over the telephone, fax, through written correspondence from credit bureaus, creditors or collection agencies. verification and research of all negative debts. If mediation of a debt is necessary I give Credit Clean a div. of WebHead Ventures, Inc, its officers, employees and agents the right to discuss information to help resolve a debt. I understand that the fees being paid to Credit Clean are fees for the service and do not include any settlement money to be paid to creditors in the event a settlement is agreed to. iiii) I further authorize Credit Clean a div. of WebHead Ventures, Inc, its agents, servants and employees bearing this release or copy thereof to obtain any information in my credit report that may involve medical records and/or credit records. I hereby direct said record holder to release such information upon the request of the bearer of the authorization to release information and durable Power of Attorney for limited purposes. I hereby release the bearer of this authorization as well as the recipient, including but not limited to, the Custodian of such records, Repository of the Court Records, Credit Bureau, (TRW, Trans Union, Equifax, Experian) consumer reporting agency, retail business establishment, lending institution, student loan agencies (public and/or private), including whatever kind, which may at any time result to me, my heirs, family or associates, because of compliance with this Authorization to release Information, or any attempt to comply with it. Should there be any questions as to the validity of this Release, you may contact me as indicated below. I have the right to revoke or terminate this Power at any time. All questions pertaining to validity, interpretation and administration of the Power shall be determined in accordance with the laws of Florida. This power is valid throughout the United States in all information set forth in the paragraph above by signatures below. iiiii) Note to Consumer: You may cancel this Power of Attorney at any time by submitting a letter stating you no longer give power of attorney to our office. This power of attorney can only be used for credit issues and will not be used for anything other than stated above. 2. Client Service Agreement a) Scope of Services: the purpose and scope to this agreement is that Client and Credit Clean have entered into a Client Service Agreement. i) Credit Clean will assist Client in obtaining current copies of credit reports and analyze the reports for the purpose of finding derogatory information affecting the credit scores. Credit Clean will pay for credit reports, however; in the event client has copies of credit reports it saves client about 30 days of time plus a monthly payment. ii) Credit Clean, as requested by client, will be acting as a Counselor/Assistant/Credit Specialist and Client authorizes Credit Clean to fully assist in the process of removing obsolete, incorrect, misleading, inaccurate, unknown and unverifiable information from each credit report that is not in compliance with the Federal Fair Credit Reporting Act, Fair Debt Collection Practices Act and any other set guidelines for creditors, credit bureaus and collection agencies. iii) Credit Clean services are to include, but not limited to, education of client in reading credit reports, counseling client and informing client of his/her rights under the Fair Credit Reporting Act and the Equal Credit Opportunity Act. Credit Clean acts as Clients personal assistant for the process of Credit Restoration and is paid by Client for such services that assist client with the restoration of his/her creditworthiness all of which is included in the monthly or full payments made to Credit Clean. iiii) Credit Clean cannot by law and does not guarantee any results from the work performed and as such; charge on a monthly basis so client has the opportunity to cease using the services of Credit Clean at any time. v) Credit Clean will provide the best possible help and will use every means available to help the Client repair and restore good credit reports in and effort to establish creditworthiness and higher credit scores. vi) Client has agreed to be responsible for all cost required to obtain consumers credit reports, restoration packet and set up fee at the beginning of service which is the initial fee of $188 for single accounts and $280 for joint accounts. Initial fee includes: Credit Reports, Credit Evaluation, Account Set Up, Use Of Client On Line Information, Credit Power Book, Miscellaneous materials such as envelopes. vii) THE FIRST MONTH OF SERVICE INCLUDES (Single Accounts): 1st MONTH $188.00 (initial fee) all other months are $115, if you need the service for 10 months, after the 10 monthly payment you will be entitled to two full months of free work. viii) THE FIRST MONTH OF SERVICE INCLUDES (Joint Accounts): 1st MONTH $280.00 (initial fee) all other months are $215, if you need the service for 10 months, after the 10 monthly payment you will be entitled to two full months of free work. viiii) The credit repair process usually takes six months of hard work although improvements are most likely seen within 60 days. You pay nothing over what is listed here to Credit Clean unless extra services are needed. x) Credit Bureaus are now commanded to give one free copy of your credit report per year. You can obtain these free reports at: www.annualcreditreport.com Credit Bureaus must also give you access to your credit scores, however; the credit scores are not free and you must pay for them in order to get them. This is a fee charged by the credit bureaus and has nothing to do with Credit Clean. Credit scores are not part of Credit Clean's Service so all scores must be obtained by client. Credit Clean's sister website: http://www.creditcrossroad.com gives you information and access to companies who offer credit reports and scores. xi) We do not charge for a phone conversation, some companies do. Credit Clean would appreciate it if you use email as much as possible to save valuable time your counselor needs doing the tedious and stressful work that needs to be done. Credit Clean understands that communication with your counselor is important and email is a much more useful way of contact since all communication is kept in your file to be referred to in the future emailing questions your counselor also has a log of you questions & concerns to refer back to when working on your credit files. xii) Our monthly fees are the same each month: Single Accounts $115 Joint Accounts $215 these fees have been increased One Time ($15) since 1995. Help us help you by following our instructions so we can keep our fees at the same rate. xiii) Client understands that the fees to obtain credit reports are regulated by the Credit Reporting Bureaus and Client is allowed by law to receive one credit report per bureau per year when denied credit by information obtained by said credit bureau. Client’s first installment is a product & service fee and is due when a client initially begins service by sending in these forms. All monthly payments are due on the first of each month and are considered late after the 10th and a $10 late fee will then become due if paid on the 11th of each month or later. If you have a problem and have to pay late let your counselor know ... otherwise processing may put your account on hold for non payment. xiiii) Total possible investment in our Full Repair for Single Client is $1338. Total possible investment for Full Repair for Joint Clients is $2430. Optional Credit Score fees are not included. Credit Clean will not be held responsible for any articles that become lost or delayed in the mail. Client is responsible for postage needed to send credit reports and other materials to Credit Clean. Please make sure you use correct postage as the post office will more than likely send postage back to you if the postage is not correct. xv) Client must notify Credit Clean if Client changes residences and cannot use the address sent in to Credit Clean at the time client began service. Having your mail forwarded is not advisable as the credit bureaus are not suppose to forward credit reports. It is very sensitive information and anyone can change an address by going to the post office. Credit Clean will re-order any reports that are missing within a normal period of time. xvi) Please be patient with this service it takes time and results are well worth the wait. xvi) Client authorizes Credit Clean, its employees and servants to prepare all necessary correspondence utilized in the processing of disputes and agree to submit to Credit Clean any additional information required to support legally the dispute process. Client understands that all disputes must be true and accurate to the best of Clients knowledge and that Credit Clean will not produce any information that is not accurate. Accurate does not mean the account can remain on a credit report there are variables and the research work that is done by Credit Clean will give us information with which to challenge negative accounts on credit reports. Credit Clean will request from credit bureaus and/or creditors, collection agencies and attorneys, verification of all information being reported negatively by the credit reporting agencies and will use every legal means of removing negative data from Clients reports so that Client can restore a more positive credit history and increase credit scores in an effort to get better interest rates and loans. xvii) Credit Clean does not change or advise Client to change Clients Identification, social security number or any other personal data in an effort to gain credit under a different identity. This is illegal and you should not use companies who offer this type of service. Client agrees to a monthly payment schedule for the Full Credit Repair & Restoration Service and that monthly payments are to be made each month. Client has the option of paying one flat fee for an entire year of service. Your initial packet will include a statement for each of the ten payments even though you many only use the service for a few months. This monthly schedule is set to help protect those with minor credit problems from paying unnecessary fees also allowing a client to stop the service at any time. Average time for completion of moderate credit problems is 6 months. Average time for completion of major problems is from 6 to 8 months. Moderate means no mediation necessary and 5 to 10 items of repair. Major means mediation with more than 10 items of repair or major derogatory credit items such as liens, judgments, foreclosure ... etc. 3) Cancellations STATE LAW REQUIRES US TO GIVE A 5 DAY NOTICE OF CANCELLATION AND FEDERAL LAW A 3 DAY NOTICE OF CANCELLATION, Credit Clean does not have any restriction on cancellation, you can cancel our service at any time we have no long term binding agreement. This is a month to month service agreement. 4) Payment Information a) Initial Fee for Single Client Accounts is $188.00. Monthly Fees are $115.00 for no more than 10 months in any one year. Two months are free if you need the entire ten months of work. b) Initial Fee for Joint Client Accounts is $280.00 Monthly Fees are $215.00 for no more than 10 months in any one year. Two months are free if you need the entire ten months of work. Joint accounts may separate and become single accounts if one party on the joint account agreement completes work prior to the other joint holder of the account. Monthly fees would also revert to single account fees. c) Flat Fee Single Client Accounts saves $115.00 and an extra month of free work is included. One full year of service for one flat fee of $1223.00 with three months of free service included instead of two. d) Flat Fee Joint Client Accounts saves $215.00 and an extra month of free work is included. One full year of service for one flat fee of $2215.00 with three months of free service included instead of two. e) Credit Scores Ordered through Credit Clean are $100 per person and includes three credit reports and three credit scores. We strongly advise that you order your own scores it is much less expensive. We have a list at: http://www.creditcrossroad.com for you to use to get scores on your own. 3. Client Notice of Rights (please read) a) 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 to 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 By clicking the "I AGREE BUTTON" You state you have read this information and agree to allow Credit Clean to help you with your credit problems. You will be asked to confirm this again in an email if this was submitted online. Important Information Important Miscellaneous Information ___________________________ IF YOU ARE NOT SUBMITTING YOUR FORMS ON LINE YOU NEED TO MAIL THEM TO US: MAIL YOUR FORMS TO: Credit Clean - NEW CLIENT DEPT 532 Bridle Path Way Tarpon Springs, FL 34688-7210 THE FOLLOWING STEPS MUST BE TAKEN ONCE YOU SUBMIT YOUR FORM TO CREDIT CLEAN: If you are submitting your form online you may fax (727) 939-8810 the required proof below. Please never fax credit reports we cannot read them and it delays our work. 1. You must send two proof of address for anyone on this form. Go to PROOF for more information on what you need to send. 2. You can submit your forms online or send them through the mail. 3. You will need to make a payment online or send a payment through the mail. Online payments can be made with a check or credit card. You can make an online payment at: http://www.creditclean.com/initial_payments.htm 4. Single account initial payment is $188.00 Joint account initial payment is $280.00 PROOF YOU WILL NEED TO SEND TO US You may want to check and make sure you have all this together so you can send it to us as these items are required no matter what Credit Clean Service you are using: Proof of Address: You need (2) items below and they must show the address you want mail to be sent to. This must be the address you want your credit reports and other information to go to. You can use a P.O. Box or a Physical Address. Be careful using a business address, the address you send proof of is the address they will list on your credit reports as you home address. Proof can be any of the following as long as it has the address you want to use and you have two of six items you can use as proof. • Driver's License • Major Credit Statement • Voided Check • Lease Agreement • Utility Bill • State I.D. You must send two of the above proof of address and if you are a joint account you must send (two) of the above proof of address for each person. Proof of Social Security Number: You only need (1) of these. This can be proven with any of the following: • Social Security Card • Filed Tax Returns • Employer Pay Stub Driver's License or State I.D. You should send a copy of your Driver's License even if it does not have your current address. It will show proof of your previous address, date of birth and driver's license number. Some states use your Social Security Number as your Driver's License Number. JOINT ACCOUNTS both of you need to send proof for each of you using the same directions above. Thank you
HEADING	End Of Step One Clicking below will take you to the next step while submitting this form to Credit Clean. Submitting this form confirms that you agree to the Terms & Conditions. You will have a chance to print the terms & conditions plus client duties at the end of these forms. Please don't submit this form unless you are ready to start this service.

THANK YOU

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Page Last Updated
Monday March 10, 2008

Credit Clean
532 Bridle Path Way
Tarpon Springs, FL 34688-7210
Phone: 727-939-0311 Mon - Fri 10 - 7 EST