Credit Repair Form

1 Personal information

First name *

Last name *

Phone *

Email *

SSN — last 4 only *

Last 4 only · we confirm the rest by phone.

2 Your goals

What do you want to accomplish? (check all that apply)

Plan you're interested in

One-time $99 audit, billed only after your first disputes are mailed. Monthly plans are billed after that month's work is done.

Approx. current score (optional)

Target date (optional)

3 Credit monitoring

We work from your three-bureau credit reports. Create a monitoring account (takes about 5 minutes), then come back and enter your username below.

Create monitoring account ↗

Monitoring service

Monitoring username / email

Never enter or email your password. We'll get login access by phone or through the provider's share-with-advisor option.

You pay the monitoring provider directly and can cancel anytime with them. Premium Credit Partners may earn a referral fee when you use our partner link, at no extra cost to you. You may use any three-bureau monitoring service you prefer.

4 Documents

Photos from your phone are fine — make sure all four corners are visible and the text is readable.

Front of ID * Driver's license or state ID Tap to choose a photo or file Back of ID * Same card, back side Tap to choose a photo or file Proof of address * Utility bill or bank statement, last 60 days Tap to choose a photo or file

Images are resized automatically. Total upload limit is about 10 MB.

Anything we should know? (optional)

5 Almost done

How did you hear about us?

Referred by (optional)

I certify the information I provided is true and the documents are mine. * I agree to be contacted by phone, text, or email about my file. *

Submitting this form does not create a contract or obligate you to anything. Before any work begins, you'll receive our written disclosures and service agreement, with your right to cancel within 3 business days (federal) and 5 days (Florida). No fees are charged until services are performed. Never put your full Social Security number or any password in this form. See our Privacy Policy and Terms of Service.

Thank you — we've got it.

1 Personal information

2 Your goals

3 Credit monitoring

4 Documents

5 Almost done