Sign Up Now

Please fill out the form below to get started today or click here to download our agreeement to submit via mail or fax.

Please mail your agreement to: 8080 Beckett Center Drive, Suite 204 West Chester, OH 45069

Please fax your agreement to: 513.860.4325

For questions regarding your agreement: Call  800.818.8708 or Email  Info@CreditBack2U.com

Personal Information 1 First Name* Last Name* Address 1* Address 2 City* State* Zip* SSN* -- Date of Birth* JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031 Phone* -- Email*

Personal Information 2 First Name* Last Name* Address 1* Address 2 City* State* Zip* SSN* -- Date of Birth* JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031 Phone* -- Email*

Payment Information
Plan*	- Select One -INDIVIDUAL: $99 set up fee and 4 monthly payments of $99INDIVIDUAL: $399 one-time feeCOUPLE: $175 set up fee and 5 monthly payments of $99COUPLE: $599 one-time fee
Method*	- Select One -PayPal®Mail Payment

Counselor's Name (if you have already spoken with someone)

*Terms and Conditions I agree and understand what I am signing, and acknowledge that I have received a copy of the General Terms and Conditions by printing or saving this document.* *A Summary of Your Rights Under the Fair Credit Reporting Act I have received a copy of Consumer Credit File Rights by printing or saving this document.*

Signatures
By signing below, you indicate that you have read and understand everything above.
Signature #1*	09/04/2010
Signature #2	09/04/2010

Please enter the code from the security image:

Code*