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NO MONEY DOWN

YOU DON'T MAKE YOUR FIRST PAYMENT UNTIL
THE MONTH AFTER OUR SERVICE STARTS

NO SET UP FEE � NO HIDDEN CHARGES � CANCEL AT ANYTIME

UNLIMITED DISPUTED ITEMS - AT NO ADDITIONAL CHARGE

UNLIMITED REMOVED ITEMS - AT NO ADDITIONAL CHARGE

All For One Low Price of:

$59.95 per Month

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Please fill in completely.
This application will automatically be stamped with the submission date of5/15/2008

Credit Repair Application

US Applicants ONLY

*	Indicates Required Field.

First Name

Last Name

Address

Apt./Suite

City:

State:

Zip:

Daytime Phone

()- EXT:

Evening Phone

()-

Mobile Phone:

()-

Date Of Birth:

// (MM/DD/YYYY)

SSN:

--XXX-XX-XXXX

Do you already have your credit reports?:

Billing Information

Same as Above

First Name

Last Name

Address

Apt./Suite

City:

State:

Zip:

Please Select To Pay By Either Credit Card or Through Your Checking/Savings Account more info

Select Payment Type:

Payment:Credit Card

Please charge my credit card $59.95 on the 15th day of the month.

Card Type:

Credit Card Number:

Format: ###############

Expiration Date:

V-Code Number:

3 digit number located on the back of Visa, MasterCard or Discover or 4 digit number located on front of American Express cards

Payment:Electronic Debit

Electronically debit my checking/savings account $59.95 on the 15th day of the month, using the account information below.

Account Type:

Bank Acct Number:

ABA Routing Number:

-- 9 digit Number ( If you do not know your account routing number enter 000-000-000)

Bank Name:

Bank City:

Bank State:

Promotional Code

Agreement& Consumer Rights

You must read, check-off, and initial both the Credit Repair agreement and the Credit File Rights documents linked below

Credit Repair Agreement

Yes, I have Read & Agree to the Terms of the Credit Repair Agreement
Enter Initials

Consumer Credit File Rights

Yes, I have Read & Understood My Consumer Credit File Rights
Enter Initials

*** LEGALLY REQUIRED DISCLOSURE STATEMENT ***

I hereby agree to the above noted payments on the dates which I indicated.

I hereby agree that LCRC may charge these amounts in the manner in which I have specified.

I hereby acknowledge that I have read the following disclosure statement:

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.

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 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

*** ELECTRONIC SIGNATURE/POWER OF ATTORNEY ***

LCRC will do its best to restore your good credit. To do so, we need permission from you to write and sign letters to the credit bureaus and creditors in your name. By granting LCRC a power of attorney you give LCRC permission to write letters on your behalf.

Your electronic signature is a Power of Attorney and authorizes us to represent you under the Fair Credit Reporting Act and other laws. You may cancel your electronic authorization by sending the LCRC an email notifying us that you retract your electronic authorization. Since we will not be able to represent you without this electronic authorization, canceling it will also close your case.

*** NOTICE OF CANCELLATION ***

LCRC allows you to cancel this agreement any time you feel you have achieved your desired results. In addition, federal law requires us to provide you with the following Notice of Cancellation form in bold and in duplicate:

NOTICE OF CANCELLATION

YOU MAY CANCEL THIS CONTRACT, WITHOUT ANY PENALTY OR OBLIGATION, AT ANY TIME BEFORE MIDNIGHT OF THE 3RD 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 LEGAL CREDIT REPAIR CENTER AT 3900 WEST COMMERCIAL BLVD. SUITE 201, FT. LAUDERDALE, FL 33309

I HEREBY CANCEL THIS TRANSACTION,
[ DATE ]
[ PURCHASER'S SIGNATURE ]
[SS#]
[PRINTED NAME]

NOTICE OF CANCELLATION

YOU MAY CANCEL THIS CONTRACT, WITHOUT ANY PENALTY OR OBLIGATION, AT ANY TIME BEFORE MIDNIGHT OF THE 3RD DAY WHICH BEGINS AFTER THE DATE THE CONTRACT IS SIGNED BY YOU.

I HEREBY CANCEL THIS TRANSACTION,
[ DATE ]
[ PURCHASER'S SIGNATURE ]
[SS#]
[PRINTED NAME]

While information is essential to provide superior service, our most important asset is our client's trust. Keeping client information secure and confidential is LCRC's top priority.  The following is the Privacy Policy for clients:

LCRC will safeguard, according to strict standards of security and confidentiality, any information our clients share with us.  LCRC will always maintain control over the confidentiality of client information.  LCRC will not share client information with any outside organization unless we have been authorized by the client, or are required to do so by law.  Further, LCRC will not rent, lease, sell or in anyway share client information to any outside organization or individual.

LCRC will limit the collection and use of customer information to the minimum we require to deliver superior service to our clients; this includes advising our clients about our services and administering our business.

LCRC will permit only authorized employees, who are trained in the proper handling of client information, to have access to that information. Employees who violate our Privacy Policy will be subject to LCRC's disciplinary procedures.

LCRC may hire other organizations to provide support services, when this happens LCRC will require them to conform to policy standards and to allow us to audit them for compliance.

LCRC will continuously assess procedures to ensure that customer privacy is respected. LCRC will conduct business in a manner that fulfills this policy.  This policy is subject to change at any time.