I hereby retain ALVIN GILBERT and / or its designated
associates(s), including legal counsel, as my true and lawful attorney-in-fact with
power and authority to represent me in the following activities:
A.
Communicate and
negotiate with banks, financial institutions, credit agencies, credit bureaus,
creditors, collection agencies, court, the Internal Revenue Service, student
loan, associations, attorneys, medical professionals and other organizations
and individuals.
B.
The acquisition
of records and other documents from any organization.
C.
The disputation
of any information recorded or published by an organization or individual named
in paragraph A on the basis of accuracy, timeliness, or verifiability.
D.
All the necessary
actions to correct and enhance my credit record by designated associate(s) and
/ or legal counsel.
E.
The payment
settlement, debt elimination, consolidation, or arrangement for payment
installment of any account held by any organization or individual named in
paragraph A.
F.
The creation and
signing on my behalf of all documents necessary to correspond with any
organization or individual named in paragraphs A and D.
G.
The engagement of
the legal counsels and associates to aid in the completion of proceeding
activities.
______________________________________________ __________
Name 1 (Print) Signed Date
______________________________________________ __________
Name 2 (Print) Signed Date
CUSTOMER INFORMATION SHEET AND FEES
Section A. (General Information)
Legal Name:
___________________________________________________________________________
Legal Name:
___________________________________________________________________________
Social Security Number:
_______________________________ Date of
Birth: ______/_______/________
Social Security Number:
_______________________________ Date of
Birth: ______/_______/________
Address:
Telephone #:
___________________ Cell Phone:
____________________ Email:
__________________
Employer Name:
_______________________________________________
Phone: __________________
Employer Address:
Occupation:
_____________________________________
Monthly Income: _______________________
Section B: (Payment Fees) * Please make checks payable
to: AC Gilbert
Total Cost for Report
Analysis: $550.00 for individual / $850.00 for couple
Wire transfer
Cash
Cashier Check
Money Order
Checks
Section C: (For Office Use Only) 100% MONEY BACK
GUARANTEE
Name of Agent: A.C. Gilbert
(Business) Credit Repair
Address:
Telephone: 1.662.680.6977
ACCOUNT #:
_______________________________
Section D: (CUSTOMER RECEIPT)
X_____________________________________________________ Date _______/_______/________
Signature
`
Signature