ONLINE ENROLLMENT QUESTIONNAIRE

When you enter your information, please double check to makes sure ALL the information entered is correct before pressing submit
You are REQUIRED to keep MONTHLY credit monitoring for us to see all 3 of your credit reports every 30 days, in order to update you with any changes, such as deletions/updates that have occured.

It is impossible for us to do our job without you having credit monitoring. So, if you cannot afford to pay $26.99 monthly for credit monitoring, please do not sign up for our service. If you downgrade your credit monitoring during our program, we will cancel your account with us.

The account that you sign up with is the one that you need to keep until you cancel services. The cheaper plans do not give us all of the information that we need.

Again, if you cannot afford to pay $26.99 a month for credit monitoring, simply do not sign up.

3. Do not enroll if you have an active bankruptcy as we will not be able to help. Dismissed/Discharged bankruptcies are OK.

4.Do not enroll if you are not able to complete your on-boarding within 48 hours. It takes no more than 20 minutes to complete on-boarding. If it is going to take you longer than hours, please do not sign up for our services.

5.Do not sign up if you are currently behind on paying your bills. We do not want our services to be another bill added on as a burden for you. Old accounts are fine. But if you are behind on your current accounts, please do not sign up

Enter Your Last Name As It Appears On Your Driver's License *

Enter Your First Name As It Appears On Your Driver's License *

Enter Your Mailing Address *

City *

Zip *

State *

What is Your Date of Birth? *

What Is Your Cell Phone Number *

What Is The Last 4 Of Your SSN? *

What Enrollment Cost Will You Be Paying Today? *

What Monthly Fee Will You Be Opting Into? *

Can You Afford The Additional Monthly Fee of $26.99 To Monitor Your Credit Scores? *

Yes

Are You Currently Late On Any Billing? *

Yes

Are There Any Collections That You DON'T Want Us To Tackle? *

Are There Any Collections That You DON'T Recognize? *

Do You Have A Stable Income Coming In Each Month? (we ask this because you will also have to add an account to build your credit) *

Yes

Do You Expect Any New Inquiries To Be Added During Credit Repair? (will you be applying for something that will require your credit to be pulled) *

Yes

Credit Card Authorization

By signing, I authorize Dynamic Credit Repair to automatically charge the card I have designated to pay for the services I purchased from Dynamic Credit Repair in accordance with the payment schedule and terms of my new client contract.

I agree and authorize Dynamic Credit Repair to adjust the payments to reflect any late fees that occur during the term of service.

If I have designated a debit card, I acknowledge my responsibility to ensure there are sufficient funds in my bank account at the time of each scheduled debit. If there are insufficient funds in my account, I understand Dynamic Credit Repair may charge me an NSF fee and that Dynamic Credit REpair may at its discretion attempt to process the charge again within 30 days to avoid cancellation.

I also understand that my membership may cancel or expire due to nonpayment if an automatic payment is rejected.

I understand that this authorization will remain in full force and effect for the remainder of the membership or until Dynamic Credit Repair has received a written notice from me of its termination.

I agree to notify Dynamic Credit Repair of any changes to my credit/debit card information or termination of this authorization at least 3 business days prior to the next billing date.

If my scheduled payment falls on a weekend or holiday, I understand that the payment still will be executed on the day I select in this agreement.

I acknowledge that the origination of transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute the scheduled transactions with my bank or credit card company; provided the transactions correspond to the terms indicated in this authorization form. Dynamic Credit Repair reserves the right to terminate this Authorization and cancel your membership at any moment.

Your Signature *

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