Personal Information

First Name:

Last Name:
Street Address:
City:
State/Province:
Zip Code:
Phone Number:
Alternate Phone Number (Optional):
Email Address:
Date of Birth (mm/dd/yyyy):
/ /
Social Security Number: - -

Select Your Account Representative (If Applicable):
 
Program Enrollment
 
Please select a program :

Please enroll me in the Standard Program.
(Registration: $79.99 Monthly Fee: $59.99)
Please enroll me in the Platinum Program.
(Registration: $99.99 Monthly Fee: $79.99)
Please enroll me in the Platinum PlusProgram.
(Registration: $99.99 Monthly Fee: $99.99)
Please select a start date:

Payment Information
Please select a method of payment.
Credit Card
Card Number: Security Code (V-Code):
Credit Card Type:
Expiration Date:
/

Bank Account

Type of Account:
Routing Number:
Account Number:
Billing Information (If different from above.)

First Name:

Last Name:
Street Address:
City:
State/Province:
Zip Code:

Credit Correction Agreement and Disclaimer
Print the agreement.      Print the disclosures.
Imprima el contrato.    Imprima los revelaciones.


By checking this box, I, the client, give Good Life Credit and their attorneys, Friedman & Brown, LLC, Power of Attorney for the purpose of requesting and obtaining credit reports and any related information in order to dispute and verify credit items. The client also confirms they have read and accept the terms of the credit correction agreement and disclosure, have printed and received a copy of the agreement, disclosure, and cancellation form, and authorizes GLC to communicate with all credit bureaus and creditors via telephone, email, and letters and to sign letters on the client's behalf. The client acknowledges that this submission is a valid electronic signature.


You may cancel this contract without penalty or obligation at any time before midnight of the 3rd business day after the date on which you signed the contract. See the Notice of Cancellation form (Formulario de Cancelación) for an explanation of this right.