SIGN UP This Contact is an Affiliate as well YesNo First Name (required) Last Name (required) Email (required) YOUR ADDRESS (If you are using someone else’s credit card, please include their name and billing address in the “comments” section below.) Address City Postal Code Country State CREDIT CARD INFORMATION. Card Number CVV Expiry Month JanFebMarAprMayJunJulAugSepOctNovDec Expiry Year By agreeing to this initial arrangement, you acknowledge and agree to the following: Credit Audit Service: We will conduct a thorough credit audit for you. This service will be initiated once you provide us with a login to your account with a credit report provider. No Charges Until Final Agreement: You will not be charged for the credit audit or any related services until you have reviewed the results and signed a final agreement to proceed with any additional services. Right of Cancellation: You have the right to cancel this agreement within five (5) business days from the date of acceptance, as outlined above. TO PROTECT YOUR PERSONAL INFORMATION FROM GETTING IN THE WRONG HANDS, WE REQUIRE THE FOLLOWING ADDITIONAL INFORMATION. Social Security Number Date of Birth Phone Mobile Fax OTHER INFORMATION Referred By Coupon Comments DOCUMENTS Driver's License / ID Social Security ID Utility Bill Document #1 Document #2 Document #3 CREDIT PROVIDER LOGIN Select Credit Provider —Please choose an option—www.123IDScore.comwww.IdentityIQ.comwww.SmartCredit.comwww.IdentityClub.comwww.MyFreeScoreNow.comwww.PrivacyGuard.comwww.MyScoreIQ.comwww.IDClub.comwww.CreditHeroScore.com Username Password Last Four Digits of SS Are you a human?
