Credit Repair Services Improve Your Credit Score

Customer Sign Up Form

Please select a plan then provide the following information about yourself:

SELECT PLAN:
SELECT CREDIT REPORT OPTION:	Order my credit reports for me ($49 - Single Account, $59 - Joint Account) I'll order my own reports and send them to Credit Repair Doctor within 30 days of signup.
SELECT YOUR TRACK SPEED:	Fast Track Service (One Time Fee $149.00 Single Account, $199.00 Joint Account) Standard Service: (No Additional Fee)
CURRENT ADDRESS
First Name
Last Name
Street Address
City
State
Zip Code
PREVIOUS ADDRESS
Street Address
City
State
Zip Code
ADDITIONAL INFO
E-mail Address
Social Security Number	( Please enter in the format 999-99-9999 )
Date of Birth	( Please enter in the format mm/dd/yyyy )
Primary Phone	( Please enter in the format (999) 999-9999 Ext. 9999)
Alternate Phone Number	( Please enter in the format (999) 999-9999 Ext. 9999)
HOW DID YOU HEAR ABOUT US?:
* If you selected Other, please tell us the name of the referring party.

SPOUSE INFORMATION	Only fill this section out IF you selected Joint Account Plan.
Spouse's First Name
Spouse's Last Name
Spouse's Date of Birth
Spouse's Social Sec. #
By checking this box I acknowledge that I have read the service agreement and give my electronic signature and power of attorney for CREDITREPAIRDOCTOR.com to perform services on my behalf.
(Please only click once and wait for next screen)