Repair

Onboarding Info

First Name *

Last Name *

Phone *

Email *

Date Of Birth *

Social Security Number *

Address

Street Address

City

State

Country

Postal Code

Have You Been At This Address For At Least 2 Years? *

Yes

If You Answered The Last Question No, List Your Previous Address Below.

Driver License / ID *

Social Security Card - results may vary without it.

Proof Of Address/Utility Bill *

ACCESS YOUR CREDIT REPORTS FOR OUR AGENCY TO MONITOR

To ensure we can actively monitor your credit reports, dispute inaccurate items, and keep you updated throughout the credit repair process, we will need you to create an account with our credit monitoring service.

If you have any questions during the setup process, feel free to reach out and we’ll be happy to assist.

https://myfreescorenow.com/enroll/?AID=PrimeCapitalGroup&PID=31315

My Free Score Now Email *

My Free Score Now Password*

Referred By?

Please Leave Any Additional Information Or Accounts That You Don't Want Removed.

By submitting my contact information I certify that I’m 18 years of age or older and that the information provided is my own. I authorize Prime Capital to contact me in forms including emails, phone calls, text messages, and voice messages. I also give written authorization to Prime Capital and/or it’s affiliates to obtain a copy of my consumer report to personalize my experience, and I understand this is optional and not required to make a purchase.

I confirm that all information I provided is true and correct, and I authorize Prime Capital to dispute the items I requested on my behalf.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.