Online Application

Use the form below to apply for our services. All fields are required.

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Contact Information
Social Security Number Enter your social security number below. Numbers only please.
Mailing Address
Agent Information Please let us know who assisted you.
Client Questionnaire
By law only completely accurate and verifiable information may be reported on a consumer's credit report. In some cases there may be information being reported on your credit report that you do not recognize and or remember the facts clearly enough to know with certainty that the reported item does in fact belong to you and or is being reported accurately. In the space below, please list any negative reporting that you know to be yours and completely accurate. Those specific reporting's will not be included in your case file that is being worked on.
Disclosure Statement

Consumer Credit File Rights Under Federal Law

You have a right to dispute inaccurate information in your credit report by contacting the credit bureau directly. However, neither you nor any credit repair company or credit repair organization has the right to have accurate, current, and verifiable information removed from your credit report. The credit bureau must remove accurate, negative information from your report only if it is over 7 years old. Bankruptcy information can be reported for 10 years.

You have a right to obtain a copy of your credit report from a credit bureau. You may be charged a reasonable fee. There is no fee, however, if you have been turned down for credit, employment, insurance, or a rental dwelling because of information in your credit report within the preceding 60 days. However, a recent federal law, the Fair and Accurate Credit Transactions Act (FACT) allows you to get one free credit report every 12 months. You may request this free credit report at The credit bureau must provide someone to help you interpret the information in your credit file. You are entitled to receive a free copy of your credit report if you are unemployed and intend to apply for employment in the next 60 days, if you are a recipient of public welfare assistance, or if you have reason to believe that there is inaccurate information in your credit report due to fraud.

You have a right to sue a credit repair organization that violates the Credit Repair Organization Act. This law prohibits deceptive practices by credit repair organizations.

You have the right to cancel your contract with any credit repair organization for any reason within three days from the date you signed it.

Credit bureaus are required to follow reasonable procedures to ensure that the information they report is accurate. However, mistakes may occur.

You may, on your own, notify a credit bureau in writing that you dispute the accuracy of information in your credit file. The credit bureau must then reinvestigate and modify or remove inaccurate or incomplete information. The credit bureau may not charge any fee for this service. Any pertinent information and copies of all documents you have concerning an error should be given to the credit bureau.

If the credit bureau's reinvestigation does not resolve the dispute to your satisfaction, you may send a brief statement to the credit bureau, to be kept in your file, explaining why you think the record is inaccurate. The credit bureau must include a summary of your statement about disputed information with any report it issues about you.

The Federal Trade Commission regulates credit bureaus and credit repair organizations. For more information contact:

The Public Reference Branch
Federal Trade Commission
Washington, D.C. 20580
Cancellation Notice

You may cancel this contract, without any penalty or obligation, at any time before midnight of the 3rd business day which begins after the date the contract is signed by you.

To cancel this contract, mail or deliver a signed, dated copy of this cancellation notice, or any other written notice to The Credit Clinic at 60 E. Rio Salado Pkwy #900, Tempe, AZ 85281 before midnight on April, 23 2019.

By law, we are required to provide you with two copies of this cancellation notice.
Please print a copy now.

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