Complete the Form to Get Started! Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* Date Format: MM slash DD slash YYYY Authorization to Release Information by Limited Power of Attorney I/We hereby give Power of Attorney and Authorization to Release Information to my agents, at DelMar Credit or any person or persons duly authorized by them to: Review a credit report, Verify and discuss all information pertaining to my accounts, and Obtain any and all information regarding my accounts. Terms and Conditions* I agree to the terms and conditions.Notifications* Please confirm receipt.I have received copies of this Information Statement and Contract for Services in its entirety and have studied it in detail before signing. I have also received a copy of the notice of cancellation and a copy of the Privacy Notice for my records.Consent I agree to the Consumer Net Impression DisclosureCredit Repair Organization’s goal is to provide credit repair services to assist CONSUMER in achieving an accurate credit report. CONSUMER hereby acknowledges that Credit Repair Organization does not guarantee any specific outcomes or results on behalf of CONSUMER, but contracts to provide the specific list of services as more fully described herein. Credit Repair Organization does not charge for, nor shall Credit Repair Organization collect for, any services, until such services as detailed in the listed contracted services are fully provided. Credit Repair Organization does not contract for services to remove accurate and/or verifiable information from CONSUMER’S credit file. CONSUMER hereby acknowledges that active participation in providing Credit Repair Organization with all requested documents, forms, and information including investigation results, is essential to providing the credit services for CONSUMER. Credit Repair Organization does not provide tax, legal or financial advice. If you need any type of legal advice, you must contact a licensed professional.Choose Your Package*First 4 MonthsTotal $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Signature*NameThis field is for validation purposes and should be left unchanged.