PLEASE SEND IN YOUR CREDIT REPORTS WITH THESE SIGNED SHEETS TO THE FAX OR ADDRESS BELOW.
NC Credit Repair
3109 Manchester Drive, Suite 101 Durham, NC 27707-3977 Tel.: 1-866-401-3426 Fax: 1-866-416-2277 Internet: www.nccreditrepair.com Email: info@nccreditrepair.com
Internal Use Only: _________________________________________ Customer Number(s)
Request for FREE Credit Report Evaluation
(Required Information)
(Each person must have their own sheets).
________________________________________
Name (First and Last on Credit report)
_________/________/_________
Social Security Number
_________________________________________________________________________________
Current Address (On Credit Report)
_________________________________________________________________________________
City State Zip
_____ - _____ - _____
Date of Birth Home Work Cell
Current Credit Scores: Equifax: ……….. _______ Experian: …..….. _______ TransUnion: ….. _______ Score Needed* ..._______
(_____) _______-________ (_____) _______-________ (_____) _______-________
(home email) ___________________________________ (work email)
___________________________________ _________________________________ (or best hours to reach you, etc.)
Preferred Method of Contact:
*Please provide the very MINIMUM score needed. We’ll always try to get it as high as possible.
1) Who referred you to our company? ______________________________________________ (necessary for form discounts). 2) ( Y / N ) Are funds available to pay down debt? How Much? Now $_______ In 3 mo $________ In 6 mo $________ 3) Revolving* Debt Accounts. List all of your open credit card and credit line accounts AND closed accounts with balances.
Credit Card/Line (not cars, houses, loans, etc)
____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________
Credit Limit
$_______________ $_______________ $_______________ $_______________ $_______________ $_______________
Balance
$_______________ $_______________ $_______________ $_______________ $_______________ $_______________
Interest Rate
_______% _______% _______% _______% _______% _______%
Monthly Payment
$_______________ $_______________ $_______________ $_______________ $_______________ $_______________
Attach additional sheets as necessary. *Revolving accounts are usually marked with a “R” (R1 – R9) on your credit report.
4) Loan Information. Please share information on the type of loan you are seeking.
Annual Income: $______________________
Loan Purpose:
___ Purchase ___ Refinance/Improve Rate ___ Refinance/Cash Out ___ Construction ___ Home Equity/Line of Credit
Time Frame:
___ As Soon As Possible ___ 3 to 6 Months ___ 6 to 12 Months ___ 12-24 Months
House Value:
$______________________
Loan Amount:
$______________________
House Type:
___ Single Family ___ Condo ___ Commercial ___ Investment ___ Co-op ___ Mobile Home ___ Multi-Family
Loan Type:
___ 30 Year Fixed ___ 15 Year Fixed ___ 5 Yr Balloon ___ 7 Yr Balloon ___ 1/ ARM ___ 3/1 ARM ___ 5/1 ARM ___ 7/1 ARM ___ VHA 30 Yr ___ FHA 30 Yr ___ FHA ARM ___ Other/See Comments
Comments:_____________________________________________________________________________________ ______________________________________________________________________________________________ _______Request for FREE Credit Report Analysis: Page (3)
5) Credit Bureau Disputes. List here the items that you think are inaccurate, not yours, misleading, wrong, etc. Item number(s)* ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________
(Attach more sheets as necessary) ** Item numbers on the RELS 3-in-1 credit report. (or you can write in the Account Name and Number) *** Common reasons are: 1) Not my Account, 2) Never Paid Late, 3) Account in Bankruptcy, 4) Account is Closed, 5) Account is Paid in Full, 6) Account was paid before it went to collections or charge off, 7) (Judgment) Satisfied, 8) Fraudulent Account, 9) Fraudulent Charges, 10) Released, 11) Bankruptcy Dismissed, 12) Bankruptcy Discharged. ***(If no information is provided we will assess disputes based on their likelihood of being removed with out evidence). If you have evidence, please notate what the evidence is and mail it with this form to the address listed above.
Reason to dispute** / Additional Info __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________
Got Evidence?*** ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N ) ( Y / N )
6) Additional Information or Comments you think we should know: _________________________________________________
_____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ ____________________________________________________________________________ (Attach more sheets as necessary)
Legal Waiver / Agreement
To use our service you must agree to the following: 1. 2. 3. I understand that NC Credit Repair will give me their personal advice on how to raise and improve my credit score only. All advice is to this ends only. All strategies presented are for this ends only. I assert that the above mentioned advice and strategies were given free of charge. And there were no charges implied. I understand that the advice given is based on a snapshot of my current situation and the current laws regulating credit bureaus, collection companies, credit companies, and credit repair companies. I follow the advice of my own accord and if I do not understand the advice given I will check with the proper legal or financial counselor before acting. I waive my right to take any legal action against NC Credit Repair or any of its owners, employees, or affiliates for following the given advice.
I understand and agree to the above 3 points.
Signature:___________________________________________________________________
Date: _________________