Applicant Information
* Indicates Required Field Input
Spanish
EDP Electronic Dispute Process
Last Name * First Name *
Middle Ini.
Date Of Birth * (mm/dd/yyyy) SSN *
Mother's Maiden N.
Mailing Address *
City * State *
Zip Code *
Home Phone * Work Phone
Cell Phone
E-mail: Fax:
Comments

Limited Power of Attorney - I hereby give authorization to request credit reports from all three consumer credit reporting on my behalf.

Credit Card Information * All Fields are Required. Complete Information As It Appears On Credit Card
Credit Card Type * Card Number *
Exp Date * (mm/yy) CVV Code *
Card Holder Name * Use
Card Holder Billing Address * City *
State * Zip Code *
Personal Check Information * All Fields are Required. Complete Information As It Appears On Check
Routing # * Account # *
Check # SSN #
Check Writer's Name * Phone # *
Check Writer's Address * City *
State * Zip Code *
Business Check Information * All Fields are Required. Complete Information As It Appears On Check
Routing # * Account # *
Check # FIN #
Check Writer's Name * Phone # *
Check Writer's Address * City *
State * Zip Code *

PLEASE ENROLL ME IN NATIONAL CREDIT EDUCATION SERVICES. National Credit Education Services will assist me to correct or remove inaccurate, outdated or unverifiable entries on my credit report. I understand that I will receive corrspondence and status reports from NCES and the credit reporting agencies through dispute cycles. Refund Policy: A change of purpose after the payment of a fee will not entitle a party to a refund of such fee. There is a $25.00 service charge for processing each payment refused (including a check returned "unpaid") or charged back by a financial institution. I hereby authorize National Credit Education Services to draft a check from a checking account or charge my credit card account that I am authorized signor for the total payment amount(s) listed above. My signature will serve as confirmation that I have read TERMS AND CONDITIONS OF ENROLLMENT and INFORMATION STATEMENT pages of this agreement.

You may cancel this contract, without any penalty or obligation at any time prior to midnight of the fifth (5th) business day after it is received by National Credit Education Services. To cancel this contract, mail or deliver a signed written cancellation notice, to Ucan2 Financial Solutions, 1010 N. Central Ave. Glendale, CA 91202, or fax 888-909-5707. If communication medium is United States Postal Service, the postmark on envelope will be used as the date of termination.

Applicant agrees to send all correspondence received from the credit agencies to the National Credit Education Services Processing Center.

I HAVE READ AND UNDERSTOOD THE ABOVE TERMS AND CONDITIONS OF ENROLLMENT.

Sponsor Distributor Name

Sponsor Distributor ID #