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CREDIT WIPING CONTRACT

Simply fillout every indicated box with the required information and click submit.  Your contract and application will automatically be emailed.  Any incomplete application will be disregarded!  We have added this feature for your convenience.   PLEASE DO NOT SUMBIT A CONTRACT UNLESS YOU HAVE MADE YOUR PAYMENT.  CONTRACTS WITHOUT PAYMENTS ARE DISREGARDED!

            CREDIT ERASER CONTRACT AGREEMENT

            This Agreement made and entered into this day; Please Enter Date: ,
            By: MR / MRS Name:      

            
            INITIALS:      
            SIGNATURE:     


            
            INITIALS:      
            SIGNATURE:     


            
            INITIALS:      
            SIGNATURE:     


            
            INITIALS:      
            SIGNATURE:     



             
            CREDIT ERASER CLIENT QUESTIONAIRE PLEASE ANSWER ALL QUESTION ACCURATELY 

            (Mr/Ms/Mrs/Jr)   :    
            First Name       :    
            Middle Name      :    
            Last Name        :    
            Mothers Madien   :    


            Email            :    
            Cell Phone Number:    
            Home Phone Number:    
            Work Phone Number:    


            SSN Number       :    
            Date of Birth    :    
            Drivers License #:    


            Current Address  :    
            City             :    
            State            :    
            Zip Code         :    
            County of        :    

            Have you lived at current address for atleast 2 years?  If Not:


            Previous Address :    
            City             :    
            State            :    
            Zip Code         :    
            County of        :    

            SPECIAL COMMENTS OR STATEMENTS
             
             
             

            SIGNATURE AUTHORIZATION STATEMENT: BY SIGNING THIS CONTRACT YOU AGREE TO 
            EVERYTHING HEREIN AND AGREE WITH DISCLAIMER FOUND ON OUR WEB PAGE.

            
            INITIALS:      
            SIGNATURE:     



            
            INITIALS:      
            SIGNATURE:     



            The Information Provided Within This Contract Is Authorized By:

            Contract Signature:     
            Your Full Name:         
            Authorization Date:     

            Signed By: Matt Cohen; A Consumer Holding Trust; DBA www.creditwiping.com

            
            

BY CLICKING SUBMIT YOU AGREE TO THE TERMS HEREIN AND WITHIN THIS CONTRACT

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