Credit For Real

Po Box 2775, Smyrna, GA 30081

Phone: 404-438-7154 Fax: 1-877-660-7740

CLIENT APPLICATION AND AGREEMENT

APPLICANT INFORMATION Circle One: Mr. Ms. Mrs. PLEASE PRINT CLEARLY
Last Name First Name Middle initial Social Security Number

Nelson Corinthia 256-55-6332

Mailing Address Home Telephone Number

1710 Winterset Pkwy

City State Zip Code Date of Birth Work Telephone Number
Month Day Year
Marietta GA 30067 12 / 03 / 1986
Email Address Fax Number Cellular Phone Number
cncece05@gmail.com 678-768-4795
REPRESENTATIVE INFORMATION CREDIT MUST BE OBTAINED FROM THE CREDIT REPORTING AGENCIES
Representative Name (First Last) REP ID# Business Telephone Number
Credit Real Admin 206-337-5035
Email Address crdt4rl@aol.com
FOR REP. USE ONLY Fee Amount Postage Fees Total
$250.00
COST TO CUSTOMER
PAYMENT METHOD [ ] CASH [ ] CHECK/MONEY ORDER
If Paying by Credit If Paying by Driver's License Number (or State ID Card #) State
Card, Select One: Check, Select one:
[ ] Personal Check

[ ] Cashier's Check Make Checks Payable to: Credit For Real

[ ] Money Order **** A $35.00 HANDLING CHARGE WILL BE ADDED IF YOUR CHECK IS RETURNED. ****

Does the address on the photo ID match

[ ] Company Check
the Address provided on this Application?
[ ] YES [ ] NO
Credit Card Expiration Date (MM/YY)
Number
Billing Address City / State / Zip Code (If different than above) Name on Card

Signature of Date
Card Holder
FOR OFFICE Amount Paid Check Number Payment Received By Information Entered By
USE ONLY
I hereby state that I have read this credit card and I am satisfied that it belongs to the above named person. I assume full responsibility for any
transactions that will result in fraudulent disciplinary action up to and including prosecutions.

The Client may cancel this contract at any time prior to Midnight of the third (3rd) day after it is received by Credit For Real.
Please see Terms and Conditions for “Notice of Cancellation”.
I hereby enroll as a Client to Credit For Real. I also agree to the I hereby agree as a Representative to assist my customer to immediately
Terms & Conditions set forth on Client Agreement Page 2 of 2. send out for their credit card reports.

Representative Signature Credit Real Date

Client Signature Corinthia Nelson Date R e c e i v e d b y C r e d i t F o r R e a l D a t e

Client Agreement- Page 1 of 2 Client: Nelson, Corinthia File ID: 8 Client ID: 8