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CLIENT CONSENT TO ACCESS CREDIT INFORMATION FROM:
EXPERIAN-TRANS UNION-CSC/EQUIFAX
 

DATE: REFERRAL SOURCE:
SINGLE    JOINT    
     
CLIENT NAME:    

LAST:

FIRST: MIDDLE:
ADDRESS:

CITY:

 STATE: ZIP:
     
SS#: DATE OF BIRTH:
EMAIL ADDRESS: WEB SITE:
EMPLOYER:   WORK#:
HOME#: PAGER# MOBILE#:
MOTHER’S MAIDEN NAME:
PREVIOUS ADDRESS:
     

SPOUSE INFORMATION

CLIENT NAME    
LAST: FIRST:: MIDDLE:
ADDRESS:
CITY: STATE: ZIP:
     
SS#: DATE OF BIRTH:
EMAIL ADDRESS: WEB SITE:
EMPLOYER:   WORK#
HOME# PAGER# MOBILE#
MOTHER’S MAIDEN NAME:
PREVIOUS ADDRESS:
     
PURPOSE FOR SERVICE:HomeAutoCredit Card Other
     
     

A-1 Credit .
Service agreement fee schedule

This fee schedule is incorporated and made a part of the service agreement between the Company and Client. If payments are not made in accordance with this schedule, all work will stop until the account has been brought current. (*This schedule does not include settlement and negotiation of tax liens and judgments.)
     
Base Fee : 

 $850

  
Bankruptcy :

$100

  
Tax liens/ Judgments* :

$100

  
Student Loan : $100  
Repossessions : $100  
Child Support : $100  
Foreclosure : $100  
Couple/Spouse : $250  
Other Fees From Schedule :

$

 
Total Gross Fee : $  
Initial Pay Discounts (20%) : $  
Total Net Fee : $  
Initial Payment (minimum #350): $  
Balance Due : $  
     
Plan A

You may receive a 20% discount when paying the “Total Net Fee.”

The 20% discount is available only if the “Total Net Fee” is paid.

 Plan B

Pay the “Total Gross Fee” by paying initially at least $350 and the balance paid in the next 60 days.

If you cannot pay the total net fee to receive the discount at this time, to get started you may pay at least $350 with the balance of the “Total Gross Fee” paid in the next 60 days.

 Plan C

Pay the “Total Gross Fee” by paying initially at least $350 and financing the balance over the next six months.

You may pay an initial fee of $350 and finance the balance over the next six months. However, you are not eligible for the 20% discount.
  Charge my credit card for the above agreed upon fee schedule.
  Mastercard Visa Amex Discover
  Expiration Date:
  Credit Card no.:
  Draft my account in accordance with the above agreed upon fee schedule.
  Account Name as Shown on Bank Records
  Bank Name
  Address of Bank or Branch
  Account Number
  Bank Transit Number