Do you already have MyFreeScoreNow Credit Monitoring? *

Yes

No

If no, you will be redirected upon submission to obtain credit monitoring services.

First Name *

Middle Name

Last Name *

Address

Street Address

City

State

Country

Postal Code

Have you lived here more than 3 years? *

Yes

No

Previous Street Address

Previous City & State

Previous Zip Code

Phone *

Email *

Date of birth *

Referred By:

Upload Unexpired Government-issued ID *

Drivers License or state ID card; make sure document is legible

Upload Your Social Security Card *

Make sure image is legible

Reasons / Goals for Credit Repair *

Upload a Utility Bill or Phone Bill (PDF if Possible) *

Make sure current address is on the bill

Have you ever used a credit repair company to dispute accounts before? *

Yes

No

Do you have any open collections, judgements, or liens? *

Yes

No

I'm not sure

What is your current credit score range? *

Are you currently in a debt management program *

Yes

No

By signing below, I acknowledge and agree to the following:

I am voluntarily requesting credit repair and related financial education services from The Wealth Effect Group. I understand that credit repair involves disputing inaccurate, unverifiable, or outdated information with consumer reporting agencies and creditors, and that no specific outcome, score increase, or timeline is guaranteed.

Signature *

Clear

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business. I agree to receive email communication from this business as well.

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