America's Oldest Credit Repair Company - Walk Away from Bad Credit ™
718-743-4040
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Consumer Credit File Rights Under State and Federal Law
You have a right to dispute inaccurate information in your credit report by contacting the credit bureau directly. However, neither you nor any "credit repair" company or credit repair organization has the right to have accurate, current, and verifiable information removed from your credit report. The credit bureau must remove accurate, negative information from your report only if it is over 7 years old. Bankruptcy information can be reported for 10 years.
You have a right to obtain a copy of your credit report from a credit bureau. You may be charged a reasonable fee. There is no fee, however, if you have been turned down for credit, employment, insurance, or a rental dwelling because of information in your credit report within the preceding 60 days. The credit bureau must provide someone to help you interpret the information in your credit file. You are entitled to receive a free copy of your credit report if you are unemployed and intend to apply for employment in the next 60 days, if you are a recipient of public welfare assistance, or if you have reason to believe that there is inaccurate information in your credit report due to fraud.
You have a right to sue a credit repair organization that violates the Credit Repair Organization Act. This law prohibits deceptive practices by credit repair organizations.
You have the right to cancel your contract with any credit repair organization for any reason within 3 business days from the date you signed it.
Credit bureaus are required to follow reasonable procedures to ensure that the information they report is accurate. However, mistakes may occur.
You may, on your own, notify a credit bureau in writing that you dispute the accuracy of information in your credit file. The credit bureau must then reinvestigate and modify or remove inaccurate or incomplete information. The credit bureau may not charge any fee for this service. Any pertinent information and copies of all documents you may have concerning an error should be given to the credit bureau.
If the credit bureau's reinvestigation does not resolve the dispute to your satisfaction, you may send a brief statement to the credit bureau, to be kept in your file, explaining why you think the record is inaccurate. The credit bureau must include a summary of your statement about disputed information with any report it issues about you.
The Federal Trade Commission regulates credit bureaus and credit repair organizations. For more information contact:
The Public Reference Branch
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Federal Trade Commission
Washington, D.C. 20580
Acknowledgment
I, the undersigned Client, hereby acknowledge receipt of this Information Statement.
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NOTICE OF CANCELLATION
You may cancel this contract, without any penalty or obligation, within
three days from the date the contract is signed.
To cancel this contract, mail or deliver a signed and dated copy of this
cancellation notice, or any other written notice, to Contact USA, Inc., P.O. Box 290765,
Brooklyn, NY 11229-0765, not later than midnight
I hereby cancel this transaction.
___________________________________________
Client's signature
___________________________________________
PRINT Full Name
___________________________________________
Date
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NOTICE OF CANCELLATION
You may cancel this contract, without any penalty or obligation, within
three days from the date the contract is signed.
To cancel this contract, mail or deliver a signed and dated copy of this
cancellation notice, or any other written notice, to Contact USA, Inc., P.O. Box 290765,
Brooklyn, NY 11229-0765, not later than midnight
I hereby cancel this transaction.
___________________________________________
Client's signature
___________________________________________
PRINT Full Name
___________________________________________
Date
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REQUIRED NOTIFICATION
of
PRIVACY POLICY
Contact USA, Inc.
P.O. Box 290765
Brooklyn, NY 11229-0765
tel. 718-743-4040
fax 845-621-4449
www.Contact-USA.com
CustomerRelations@Contact-USA.com
Our annual Privacy Policy Notice
In order to provide you with the best of service our privacy policy is simple.
We
do not
share any nonpublic personal information about you with anyone.
Collection of personal information:
We collect nonpublic personal information about you from the following sources:
Information we receive from you verbally, on applications, data entry forms filled out by you, credit reports submitted by you for review or correction, from transactions with us, copies of your identification documents or other form of documents submitted by you, from consumer reports or from other sources.
Use of personal information:
We share personal information with certain of our employees in order to enable them to perform regular business functions, such as performing the services which we provide to our customers.
Sharing of your personal information:
We do not disclose any nonpublic personal information about you to anyone, except as permitted by law or when you instruct us to order your credit reports or dispute certain information on your credit reports. In such cases, in order for you to receive your credit reports, your name, address, previous address, social security number, date of birth and copies of your identifying information (driver's license, bills with your current address and a proof of your social security number) will be released to the credit reporting agencies.
Security of your personal information:
We have implemented and maintain security procedures which include, security, confidentiality and safeguarding of your personal data.
We will continue to follow our privacy policy even when you are no longer our customer.
No response is required, however if you have any questions regarding this notice or would like to be removed from our lists please contact us at 718-743-4040.
KEEP FOR YOUR RECORDS
Created in June of 2001. Updated: 1/2002, 1/2003, 1/2004, 1/2005, 1/2006, 1/2007, 1/2008, 1/2009, 1/2010, 1/2011, 1/2012, 1/2013, 1/2014, 1/2015, 1/2016 and January of 2017.
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This is
Contact USA's
Secure Order site.
If you prefer to submit your form via mail, e-mail or fax
CLICK HERE
to Download this Form.
Credit Reports/Scores Assistance and Data Entry Form
(
*
= required fields)
How did you find out about Contact USA?
*
Referred
Yellow Pages
Internet
Other
If referred - Who referred you to us?
Please choose Reports only or Reports AND Credit Scores
*
$99 - Reports
$149 - Reports and Scores
Salutation
*
Mr.
Mrs.
Ms.
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First Name
*
Middle Initial
Last Name
*
Generation
Jr.
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II
III
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Address
*
Apt./Suite/Floor
City
*
State
*
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Zip Code
*
Years at this Address (1,2,3, etc.)
*
Home Telephone (212-123-4567)
*
Work Telephone (212-123-4567)
Cellular Phone (212-123-4567)
Date of Birth (MM/DD/YYYY)
*
Social Security Number (123-45-6789)
*
Your Occupation
*
Your E-mail Address
*
Marital Status
*
Married
Single
Separated
Divorced
Widowed
Previous Address
Do you feel that your credit reports contain inaccurate, erroneous or obsolete information?
*
Yes
No
Have you been turned down for credit, insurance, employment or rental during the last 60 days?
*
Yes
No
If yes, please provide names of all denying creditors
Select your Employment status
*
Unemployed
Self Employed
Employed
Retired
Student
Do you intend to apply for employment in the next 60 days?
*
Yes
No
Employer
Are you a recipient of public welfare assistance?
*
Yes
No
Do you suspect fraudulent activity on your credit reports?
*
Yes
No
Are all previous delinquent accounts (if any) paid?
*
Yes
No
If paid, do you feel that your credit reports do not reflect such paid or discharged status?
*
Yes
No
List any additional notes or relevant information
Terms
I am the person named above, I am requesting the assistance of
Contact USA, Inc. to obtain my credit reports from the three major credit bureaus for a fee of $99 or $149 if also ordering credit scores. My credit reports or/and credit scores
will be mailed to the address provided above. I am aware that I may obtain these credit
reports on my own. In some cases Credit Reporting Agencies
might request copies my your driver's license, utility bill or any other
billing statement with my current address and social security number.
In such case and upon Contact USA, Inc.'s request, I will provide such copies
directly to Contact USA, Inc. This is not a credit repair contract. If I choose
to engage Contact USA, Inc. for the purposes of removing and/or modifying inaccurate,
obsolete or non verifiable information contained in my credit report(s),
I will be bound by the terms of a separate agreement (the "Client Agreement")
as required by New York state and federal laws. All data relating to client
will be kept confidential. Client hereby acknowledges the receipt of Consumer
Credit File Rights Under State and Federal Law, Notice of Cancellation
(in duplicate) and Contact USA, Inc.'s Privacy Policy. By selecting "I Agree"
and by signing my name below, I certify that the information provided by me on this form is true and correct and I agree to the above terms.
Please agree to this request
*
I Agree
I Disagree
Please sign your Full Name
*
Signed on:
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