ALLIANCE5 APLICATION

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					6855 Leetsdale Dr
Denver CO 80224

Free: 1-888-393-6949
Phone: 303-388-2220
Fax: 303-200-9012


Mail or Fax in your order
Print out the following order form and either:
Option 1:        Fax it to 303-200-9012

Option 2:
Mail it to:

AAA ALLIANCE GROUP INC
6855 Leetsdale Dr
Denver CO 80224

Step 1: Contact Information

About you:

        First Name: ____________________________
        Middle: _______________________________
        Last Name: ____________________________
        Email: ________________________________

You’re Address:
        Street (1):_____________________________
        Apt # ____________________________
        City: ____________________
        ZIP: _____________
        State: _____________

Have you lived at your current address for more than 2 years?       Yes No
If no, please provide previous address

Street (1):_____________________________
        Apt # ______
        City: ____________________
        ZIP: _____________
        State: _____________

Step 2: Confirm Your Identity

To protect your personal information from getting in the wrong hands, we require the following
additional information in order to verify your identity:

Social Security #:_____-_____-______

Phone Number: ______________________

Date of Birth: ______________________

Payment Information:
Credit Card Type: ________________________
Credit Card #: __________________________
Expiration Date: __________________
Check or Money Order:
If you are paying with a check or money order please make the payment payable to AAA ALLIANCE
GROUP INC, for a total of $____________
X______________________________                   _______________
               signature                               date
Step 2: 2ND PAGE

Authorization/Disclosure/Disclaimer:

CONSUMER CREDIT FILE RIGHTS UNDER STATE AND 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. AAA ALLIANCE GROUP INC does not claim to remove accurate information from
any credit report. 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. 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 3 business 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 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.

Limited Power of Attorney Disclosure. Be it known that I, the undersigned, am the individual and by
submitting this form hereby grant a limited power of attorney to AAA ALLIANCE GROUP INC, and any
and all persons in there employ, as my agent, to have the necessary power and authority to undertake
and perform the following on my behalf. I hereby give permission to AAA ALLIANCE GROUP INC to sign
my name on all documents written on my behalf as my agent for the purpose of disputing inaccurate,
erroneous, and obsolete credit information held on my report by consumer credit reporting agencies.
This "limited power of attorney" is given to AAA ALLIANCE GROUP INC in compliance with section 611
of the Federal Fair Credit Reporting Act.
Please review the information you have entered for accuracy and completeness.


X______________________________                   _______________
            signature                                  date

				
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