header border
people
-- Individual Account Payment Plan -- Credit Card --

Section A
-- Please fill in the information below.  All fields in bold are required--
 

First Name

Last Name

Address

City

State

Zip code

Home Phone

Date of Birth
(dd-mm-yyyy)

 

Social Security Number
(999-99-9999)

 

E-mail Address

 

How did you hear about us?

 

Section B
-- Fill out Credit Card information --

Card Type

 

Credit Card Number

 

Expiration Date

 

Card Verification
 Number

 

Customer Service
Phone Number**


** The customer service phone number printed at the back of your Credit Card
 

I authorize AHF Legal Credit Repair LLC to draft $99.00 from my bank account and auto deduct
or draft my monthly payments of $39.00. This payment will be scheduled on the monthly
anniversary of this contract. (i.e. 01/06/02, 02/06/02, 03/06/02)
 

 


Section C
-- Terms and Agreement --


I agree and understand what I am signing, and acknowledge that I have received a copy of the General Terms and Conditions and all of its provisions and attachments by printing or saving this document.



I agree and understand what I am signing, and acknowledge that I have received a copy of Consumer Credit File Rights by printing this document.


 

 

American Health and Financial Service
The Nations Largest Membership
210-399-5399 Office
210-399-5224 Fax
support@healthandfinancial.com



AHF Disclaimer. Our company mission is to offer acess to free or low cost products and or services. Our company adheres to a strict privacy policy and we never share confidential information with any third parties without your written consent.
All Information Copyright 2010 TelForce Consultants Corp Credit Repair program Optimization by: AHF.

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