Credit Repair Application

Name*
First Middle Last
Phone Type*
- Cell Phone
- Home Phone
- Work Phone
Phone Number*
Email*
Mailing address:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Address
Street Address Address Line 2 City State ZIP Code
Have you lived at your current address for more than 2 years?*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Social Security #*
Drivers LIC/ State ID #*
Birthdate*
Verification documents are required!
Their are 6 options below. 1 option is already selected and cannot be changed!
Please select only 2 more items in order to make total of 3 documents must be submitted in our secure portal.
(Please check any 2 items of your choice below. As 1 is already selected for you by default. Total items you're sending in is 3 items total.)*
- Social Security Card (Front only) *Required
- Drivers License (Front only)
- State ID (Front only)
- Passport
- Bank Statement (That shows your current address)
- Utility Bill (That shows your current address)
Upload In Box Below
Drop files here or
Accepted file types: pdf, worddoc.
You will need to send in all required documents by fax or email!
Also any correspondence that you received from the 3 Credit Bureaus. Within the next 30-90 days. Please fax or email below.
Fax: 1-800-374-8227
E-mail: docs@keypointcreditservices.com
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Today is: May 23, 2019

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