Credit Repair Enrollment Form

Credit Repair Enrollment Form

Credit Repair Enrollment Form Form Preview
Individual Enrollment Form
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    Thank you for choosing Coulter Credit - we look forward to helping you!
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    The types of personal information we collect and share depend on the product or service you have with us. This information can include: Specific product or service needs, Social Security Numbers, Credit Profile, Address & Payment Information

    All financial companies need to share personal information to run their everyday business. In the section below, we list the reasons financial companies can share their personal information; the reasons chooses to share; and whether you can limit this sharing

    Reasons we can share your info

    1. For our everyday business purposes— such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus.

    2. For our marketing purposes— to offer our products and services to you.

    3. For joint marketing with other financial companies.

    4. For our affiliates’ everyday business purposes— information about your transactions and experiences.

    5. For our affiliates’ everyday business purposes— information about your creditworthiness.

    Do we share your info?

    1. Yes, we share your info with necessary parties to help facilitate the products and services that you have contracted for.

    2. We share your info with vendors that assist us in offering various opportunities to you.

    3. We occasionally share information with other financial and non-financial entities.

    4. Yes, we share your info with affiliated parties to help facilitate your goals.

    5. Yes, we share your info with affiliated parties to help facilitate your goals.

    Can you limit this sharing?

    1. Yes, you can opt out of receiving any marketing from us for any products other than the products or service you have contracted for.

    2. Yes, you can opt out of any non-essential sharing with third parties.

    3. Yes, you can opt out of any non-essential sharing with third parties.

    4. Yes, you can opt out of any non-essential sharing with third parties.

    Please note if you are a new customer we can begin sharing your information from the date we sent this notice. When you are no longer our customer, we continue to share your information as described in this notice. However you can contact us at any time to limit our sharing.

    Should you wish to opt out of our sharing of your information pursuant to the guidelines set forth above please contact [CRO-PHONE-NUMBER] or [CRO-CONTACT-EMAIL].

  • Customer Credit Repair Agreement

    This Customer Credit Repair Agreement (“Agreement”) is made and effective on the date this agreement is signed by and between Coulter Credit, LLC (“Company”) and you the client (“Customer”).

    NOW, in consideration of the promises contained herein, the parties agree as follows:


    As used herein, the following terms shall have the meanings set forth below:

    "Products" shall mean the following Company's services to be sold by Company

    Terms and Conditions.

    Description of Service, “See Exhibit A”

    The specific services, warranties, payment terms, and total cost are set forth in the client disclosure statement incorporated herein for all purposes

    Affiliate Service Provider.

    The Company has the option of fulfilling the credit services through a third party to best serve you. For an explanation of how the Company handles your information in such circumstances see the attached privacy policy.

    Term and Termination.

    Term. This Agreement shall continue as outlined in “Exhibit A” unless terminated by company as provided herein. Thereafter, this Agreement shall continue until terminated by conditions provided within this agreement.

    Termination for Cause. Either party may terminate this Agreement upon giving the other party ten (10) days notice.

    Limitation on Liability.

    In the event of termination by either party in accordance with any of the provisions of this Agreement, neither party shall be liable to the other, because of the termination for compensation or reimbursement or damages on account of the loss of prospective profits or anticipated sales or on account of expenditures, investments, leases or commitments in connection with the business or goodwill of Company.


    Client acknowledges that by reason of its relationship to the Company hereunder it will have access to certain information and materials concerning Company's business plans, Customers, technology, and products that is confidential and of substantial value to Company, which value would be impaired if such information were disclosed to third parties. Customer agrees that it shall not use in any way for its own account or the account of any third party, nor disclose to any third party, any such confidential information revealed to it by Company. Company shall advise Customer whether or not it considers any particular information or materials to be confidential.

    Governing Law and Jurisdiction.

    This Agreement shall be governed by and construed according to the laws of the State of Pennsylvania.

    Entire Agreement.

    This Agreement sets forth the entire agreement and understanding of the parties relating to the subject matter herein and supersedes any prior discussions or agreements between them. No modification of or amendment to this Agreement, nor any waiver of any rights under this Agreement, shall be effective unless in writing and signed by the party to be charged.


    Any notices required or permitted by this Agreement shall be deemed given if sent by Certified mail, postage prepaid, e-mail, fax, return receipt requested or by recognized overnight delivery service: If to Company; At its principal place of business or if to Customer, at the aforementioned address.


    If any provision of this Agreement is held to be invalid by a court of competent jurisdiction, then the remaining provisions shall nevertheless remain in full force and effect.

    Dispute Resolution.

    In the event of any controversy, claim or dispute between the parties arising out of or relating to this agreement or the breach, termination, enforcement, interpretation, conscionability or validity thereof, including any determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration in USA County, State of Pennsylvania or in the county in which the consumer resides in accordance with the Laws of their local state law for agreements to be made in and to be performed in their state. The parties agree that the arbitration shall be administered by the American Arbitration Association ("AAA") pursuant to its rules and procedures and an arbitrator shall be selected by the AAA. The arbitrator shall be neutral and independent and shall comply with the AAA code of ethics. The award rendered by the arbitrator shall be final and shall not be subject to vacation or modification. Judgment on the award made by the arbitrator may be entered in any court having jurisdiction over the parties. If either party fails to comply with the arbitrator's award, the injured party may petition the circuit court for enforcement. The parties agree that either party may bring claims against the other only in his/her or its individual capacity and not as a plaintiff or class member in any purported class or representative proceeding. Further, the parties agree that the arbitrator may not consolidate proceedings of more than one person's claims, and may not otherwise preside over any form of representative or class proceeding. The parties shall share the cost (not attorney’s fees) of arbitration equally. In the event a party fails to proceed with arbitration, unsuccessfully challenges the arbitrator's award, or fails to comply with the arbitrator's award, the other party is entitled to costs of suit, including a reasonable attorney's fee for having to compel arbitration or defend or enforce the award. Binding Arbitration means that both parties give up the right to a trial by a jury. It also means that both parties give up the right to appeal from the arbitrator’s ruling except for a narrow range of issues that can or may be appealed. It also means that discovery may be severely limited by the arbitrator. This section and the arbitration requirement shall survive any termination.


    Headings used in this Agreement are provided for convenience only and shall not be used to construe meaning or intent.

    Conducting of Business Electronically, Consent to be Contacted.

    Customer agrees, unless specifically requested otherwise, that by entering into transactions with Company, Customer affirms consent to receive, in an electronic format, all information, copies of agreements and correspondence from Company and to also send information in an electronic format unless previously agreed upon in writing with Company. Customer has a right to receive a paper copy of any of these electronic records if applicable law specifically requires us to provide such documentation. Customer’s withdrawal of his or her consent to conduct business electronically can only occur if applicable law specifically requires Company to provide a paper copy of electronic documents. Withdrawal of consent will slow the speed at which Company can complete certain steps in transactions with Customer and delivering services to Customer. To inform Company that Customer either withdraws Customer’s consent to receive future notices and disclosures in electronic format, would like to receive paper copies, or to update Customer information, Customer may send such request to: Coulter Credit [CRO-ADDRESS-1], [CRO-ADDRESS-2], [CRO-CITY], Pennsylvania, [CRO-ZIP] . Customer acknowledges and agrees that the internet is considered inherently insecure. Therefore, Customer agrees that Company has no liability to Customer whatsoever for any loss, claim, or damages arising or in any way related to Company’s responses to any electronic communication, upon which Company has in good faith relied. At all times, Customer maintains the sole obligation to ensure they can receive Company’s electronic communications, and access them on a regular and diligent basis. Customer also agrees to be contacted by telephone on Customer’s landline and/or cell phone by Company irrespective of whether the Customer’s telephone number appears on any state or federal “Do Not Call” lists. Customer further agrees that Company may use a computerized dialing system to contact Customer via telephone or SMS text and Customer may use a pre-recorded message when contacting Customer via telephone or SMS text. Customer understands that his or her consent to be contacted does not require Customer to purchase any goods or services from Company. To inform Company that Customer either withdraws Customer’s consent to receive communications from Company as described directly above, or to update Customer information, Customer may send such request to the address listed directly above for Company.

    Client Obligations & Agreement.

    Customer will return, along with signed agreement, a copy of their driver’s license, social security card, and a recent Utility bill showing the correct address (phone bill, gas bill, electric bill, etc.).

    Customer agrees to obtain initial credit reports, with scores, from all three credit bureaus (Equifax, Experian and TransUnion) and understands that Company will not proceed with services until the initial credit reports are received by the Company. Customer also agrees to keep a credit monitoring subscription for the duration of this contract. Both obtaining an initial credit report and keeping a monthly credit monitoring subscription in good standing are NON-NEGOTIABLE.

    Customer agrees to maintain on time monthly payments of their current credit obligations (i.e. – car loan, utility bills, mortgage payments, credit cards, etc.). Failure to maintain those payments will result in severe damage to the results obtained by Coulter Credit.

    Customer agrees to contact Coulter Credit on any questions regarding their credit INCLUDING inquiries or questions regarding applying for consumer credit.

    If the Customer was referred to Coulter Credit by a referral partner, the Customer hereby expressly consents to Coulter Credit, sharing data concerning the results of the credit restoration process with the aforementioned referral partner.

    Customer agrees to payment terms and conditions as chosen in Exhibit A, which is incorporated into this agreement.

    if the Customer fails to complete the payment schedule any and all refunds are forfeited, with the exception of a Customer cancelling the Agreement within 10 business days of the Customer’s entering into this Agreement.

    Customer understands that results vary on a case-by-case basis and that Coulter Credit provides a service and has no control over removal of negative items on the credit report. Only Credit Agencies have control over results.

    Contract is for 6 months from the start date of the agreement based upon initial credit reports being received. Either party may cancel this at any time with 10 days notice, sent in written format.

    Customer will not be charged any advance monthly service fees for any Services (See Exhibit “A” for Explanation of Fees), rather such fees will only be charged by the Company to the Customer upon the Company’s completing the services for the Customer.

    Company will not remove any derogatory information (defined as accurate information appearing on the Customer’s credit report), nor will Company assist Customer on improving Customer’s credit rating or record.

    IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and year first above written.

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  • You may cancel this contract without penalty or obligation at any time before midnight of the 5th business day after the date on which you signed the contract.

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