Cleaner Credit

Are you getting respect?
Good credit is a wondrous thing.
Doors fly open and VIP treatment is the norm.

I, the undersigned, authorize CRS to prepare all the necessary correspondence for clarification of certain derogatory information which may be contained in my credit/file report.

I have read and I understand the agreement completely. I may cancel this agreement without penalty or obligation at any time before midnight of the 5th business day after the date on which I signed this agreement.

Personal Info:
First Name:
Last Name:
Middle Name:
Birthdate:	Month: Day: Year:
Social Security #:
Mother’s Maiden Name:
Current Address:
Current State:
Current Zip Code:
Have you lived at your current address for more than 2 years?	Yes No
Previous address:
Previous State:
Previous Zip Code:
Home Phone:
Work Phone:
Mobile Phone
Fax:
Email:
Client Signature: (type your full name)
Date:
Payment Method:	Credit Card Check

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