ReScore CLIENT PROFILE and APPLICATION

        Remember....You don't have to live with bad credit!

PRIMARY CLIENT INFORMATION
First Name
Middle Name
Last Name
Street Address
Address (cont.)
City	State Oregon Tennessee Kentucky Virginia West Virginia Ohio Hawaii New Mexico Oklahoma Missouri Colorado Wyoming Utah Montana North Dakota South Dakota Minnesota Ilinois Michigan New York Vermont Delaware Florida Alabama Louisianna Mississippi Kansas South Carolina North Carolina Maryland New Jersey Pennsylvania Conneticut Maine Massachusetts New Hampshire Wisconsin Indiana Iowa Nebraska California Arizona Washington Georgia Texas Idaho Nevada   Zip
	Previous Address:  if less than 2 years
Street Address
City	State Oregon Tennessee Kentucky Virginia West Virginia Ohio Hawaii New Mexico Oklahoma Missouri Colorado Wyoming Utah Montana North Dakota South Dakota Minnesota Ilinois Michigan New York Vermont Delaware Florida Alabama Louisianna Mississippi Kansas South Carolina North Carolina Maryland New Jersey Pennsylvania Conneticut Maine Massachusetts New Hampshire Wisconsin Indiana Iowa Nebraska California Arizona Washington Georgia Texas Idaho Nevada   Zip
SS#
Date of Birth
Contact Phone
Employer
Occupation
Income	Estimated Annual Income: $
FAX
E-mail
SECONDARY CLIENT INFORMATION
First Name
Middle Name
Last Name
Street Address
Address (cont.)
City	State Oregon Tennessee Kentucky Virginia West Virginia Ohio Hawaii New Mexico Oklahoma Missouri Colorado Wyoming Utah Montana North Dakota South Dakota Minnesota Ilinois Michigan New York Vermont Delaware Florida Alabama Louisianna Mississippi Kansas South Carolina North Carolina Maryland New Jersey Pennsylvania Conneticut Maine Massachusetts New Hampshire Wisconsin Indiana Iowa Nebraska California Arizona Washington Georgia Texas Idaho Nevada   Zip
	Previous Address:  if less than 2 years
Street Address
City	State Oregon Tennessee Kentucky Virginia West Virginia Ohio Hawaii New Mexico Oklahoma Missouri Colorado Wyoming Utah Montana North Dakota South Dakota Minnesota Ilinois Michigan New York Vermont Delaware Florida Alabama Louisianna Mississippi Kansas South Carolina North Carolina Maryland New Jersey Pennsylvania Conneticut Maine Massachusetts New Hampshire Wisconsin Indiana Iowa Nebraska California Arizona Washington Georgia Texas Idaho Nevada   Zip
SS#
Date of Birth
Contact Phone
Employer
Occupation
Income	Estimated Annual Income: $
FAX
E-mail
WHAT TYPE OF DEROGATORY CREDIT IS ON YOUR REPORTS
	Judgments   Bankruptcy   Tax Leins     Collections     Inquiries
	Charge-Offs     Repossession    Late-Pays    Foreclosure
OTHER:
TELL US WHERE YOU THINK YOUR SCORES ARE TODAY
(This will help us to determine the right plan to recommend)
PRIMARY CLIENT:                   EQUIFAX                  EXPERIAN                TRANS UNION
SECONDARY CLIENT:              EQUIFAX                  EXPERIAN                TRANS UNION
PLEASE SELECT THE PLAN THAT BEST FITS YOUR SITUATION
	ReScore PLATNUM
	ReScore GOLD
	ReScore SILVER
	Want More Information about the Optional Services
HERE'S THE NEXT STEP
Thank you for completing this application.  Please read this statement below, then sign.
There is NO obligation to purchase at this point.  The information contained in this application is Private, Secure and Protected.  We do not access your credit reports at this time.  We do not distribute this information.  This application is used only to evaluate how we can best serve you with our programs.  By signing below, you are only validating this application and the information contained on the form, is true and accurate.  By signing, you are also approving our receiving and evaluating this information for the purpose of recommending a Credit Restoration Plan that closely fits your financial goals.  This application is active for 24 hours from the time we respond back to you with our recommendation.  If we receive no response from you by 24 hours, this application will be canceled and deleted.  A new application will need to be submitted if you wish to continue the evaluation process.  If we receive your response within 24 hours, then the next step will be submitted to you and the final paperwork and payment process completed.
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By typing in your name(s) below, you are authorizing USCredit Save to evaluate your information.
PRIMARY CLIENT:
SECONDAY CLIENT:

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