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Personal Information

First Name* Middle Last Name*
          City* State* Zip*
    Phone #*   Home Office Cell   Phone # Cell Office Home

                   How did you hear about us?

                    Add a household member for only $40 more per month ($125 total).


    Phone #*
Click this link for a printable copy of the form if you prefer to fill out and mail the form to us:  

Printable Sign Up Form

We will contact you to complete the sign up process. If the credit bureaus do not have an updated address on you, we will need to update it. We will contact you with details if this is necessary.

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Billing Information

   Bank Name: *
ABA/Routing # *
       Account # *
 Draw From * Checking Savings



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Commonwealth Credit Repair ("CCR") will act on your behalf in attempting to remove negative and invalid items off of your credit reports from Experian, Equifax and TransUnion credit bureaus.

- STEP 1 (1 - 7 days): CCR will set-up your case and order your credit reports for you.
- STEP 2 (7 - 14 days): Your credit reports will arrive in the mail. Forward those credit reports to CCR.
- STEP 3 (as necessary): CCR will draft correspondence to remove negative items from your credit reports*.
- STEP 4 (approx. 60 days): You will receive your first results from the credit bureaus. Forward those results to CCR.

The first results will be sent to you in approximately 60 days, followed by more results once every 90 days thereafter. Always make copies of your updated credit reports for your records and mail (do not fax) the originals to CCR.

* We may send you letters that we will prepare on your behalf for you to mail out. If we do, the letters will be sealed in separate envelopes and will contain "green" certified mail slips attached to them. You must bring those sealed envelopes to your local post office and mail them (the current certified mail fee is roughly $3.28). You may keep copies of those letters.

DEBT COLLECTOR VALIDATION. If you are being harassed by debt collectors, contact us for assistance. CCR will prepare letters on your behalf and provide them for you to respond against abusive debt collectors. Do not instruct debt collectors to contact us as we do not negotiate your debts. We simply assert your rights and prepare the appropriate letters for you.

COST Single: $75 Set-up fee, $85 per month. Couple: $75 Set-up fee , $125 per month.

In accordance with federal law, CCR does not charge fees in advance. In 7 days, after your case has been set-up, you will be billed the initial set-up fee. The monthly payments are billed once every 30 days thereafter, for work performed the previous month. You may cancel this contract within the first 3 business days from the date this contract is signed or with a 30-day notice anytime after. 


1. I agree to mail all credit reports and all other letters received regarding my case to CCR within fourteen (14) days from the date they arrive in the mail, and I understand that CCR is not responsible for reminding me to send any paperwork.

2. I agree to notify CCR if I do not receive credit reports at least every ninety (90) days from all three major credit bureaus.

3. I agree not to contact the credit bureaus for any reason during the repair process, and to notify CCR if I move.

4. I agree not to pay any of my accounts that are not in collection late during the credit repair process. I understand that paying these accounts late will seriously jeopardize my results, and may drop my credit score up to 100 points or more.

5. I understand that CCR does not eliminate, cancel, consolidate or negotiate my debts.

6. I understand that there is a possibility for unpaid debts to be transferred or sold to other debt collectors. If this occurs, the new debt collectors may report the account on my credit report in the future.

7. I understand that CCR is not promising me that every negative / invalid item will be deleted from my credit report.


I. Client is hereby exercising their right under the Credit Repair Organizations Act 15 USC 1679 by retaining a third-party to repudiate all late histories and disclaim all other derogatory remarks as invalid, unless otherwise instructed in writing by client. The burden of truth regarding the accuracy and compliance of all derogatory information contained in client's credit reports shall be placed onto the credit bureaus and furnisher(s) of that information. Although CCR does not make any specific predictions as to the outcome of this case, CCR offers the following "performance" guarantees:

60% PERFORMANCE QUOTA - If CCR is unable to delete at least 60% of the original invalid negative remarks from client's credit reports in 11 months, client will receive continued service at no cost until the 60% quota is met.

200% REFUND POLICY - If CCR is unable to delete any invalid negative remarks from any of client's credit reports in 11 months, CCR will refund 200% of all fees (client must follow all instructions to qualify for a refund).

II. For the protection of intellectual property and trade secrets, CCR does not maintain copies of credit bureau FCRA/FACTA dispute letters. However, copies of all creditor and debt collector correspondence will be available to client upon request. 


Be it known that I/we, who submitted my/our electronic signature, am the individual/authorized officer of the business / personal entity listed in this agreement and as such do hereby grant a Limited Power of Attorney to Commonwealth Credit Repair. Commonwealth Credit Repair, and any and all persons in their employ, shall have the necessary power and authority to undertake and perform the following on my behalf: I hereby give permission to Commonwealth Credit Repair to act as my agent and to physically sign my name on all documents written on my behalf for the only purpose of: a) ordering credit reports, b) challenging and verifying invalid information on credit reports, and c) instructing creditors and debt collectors to validate claims.


1. Copy of your driver's license or state ID with current address. If your driver's license does not match your current address, include a copy of any one utility bill (gas, phone, electric, cable, etc.) with your name and current address.

2. Copy of your Social Security Card or document with Social Security Number on it (pay stub, tax returns, W-2, etc.)


I am signing up for an automatic payment plan. I agree that COMMONWEALTH CREDIT REPAIR or its authorized agent may automatically debit my bank account for the amount due within 15 days of the scheduled draft date (the scheduled draft date will be seven days after the date you submitted this form). I can cancel this automatic payment at any time by writing to COMMONWEALTH CREDIT REPAIR or its authorized agent. I agree that COMMONWEALTH CREDIT REPAIR or my financial institution can cancel automatic payment for my account for any reason, at any time, with or without prior notice to me. I understand that a return fee of $25.00 will be charged on all returned items. I acknowledge that the origination of these debits to my account must comply with U.S. laws. I agree that this agreement remains in effect until canceled by CHECKMATIC, my financial institution or me.



You have the right to obtain a copy of your credit file from a consumer credit reporting agency. You may be charged a reasonable fee (generally $9.00). There is no fee, however, if you have been turned down for credit, employment, insurance or a rental dwelling because information in your credit report within the preceding 60 days. The consumer credit reporting agency must provide you with someone to help you interpret 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 the right to dispute inaccurate information by contacting the consumer credit reporting agency directly. However, neither you nor any credit repair company has the right to have accurate, current and verifiable information removed from your credit report. The consumer credit reporting agency must remove accurate, negative information from your report only if it is over seven (7) years old, bankruptcy information is reported for ten (10) years. You may, on your own, notify a credit reporting agency in writing that you dispute the accuracy of information in your credit file. The consumer credit reporting agency must then reinvestigate and modify or remove inaccurate information. The credit reporting agency may not charge a fee for this service. Any pertinent information and copies of documents you have concerning an error should be given to the consumer credit reporting agency. Credit reporting agencies are required to follow reasonable procedures to ensure that the information they report is accurate, however, mistakes may occur.

If the credit bureau's reinvestigation does not resolve the dispute to your satisfaction, you may send a brief statement to the consumer credit reporting agency to keep in your file, explaining why you believe the information is inaccurate. The consumer credit reporting agency must include your statement about disputed information in any report it issues about you. Please note that there are non-profit consumer credit counseling agencies in your state who will assist you to resolve credit problems at no cost or for a nominal fee.

You have the right to cancel this contract for any reason within three working days from the date you have signed it. If for any reason you do cancel the contract during this time, you do not owe any money.

You have the right to sue a credit services organization that violates the Credit Repair Organizations Act. The Federal Trade Commission regulates credit reporting agencies and credit repair organizations. For more information, contact the Federal Trade Commission, Washington, D.C. 80580.


You may cancel this contract, without any penalty or obligation, at any time before midnight of the third business day which begins after the date this contract is signed by you.

If you cancel, payment made by you under this contract must be returned within 15 days following receipt by Commonwealth Credit Repair of your cancellation notice. To cancel this contract, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice to: Commonwealth Credit Repair 47 Pleasant St. Worcester, MA 01609 before midnight on the third business day after this agreement is submitted by you.

Digital Signature
  Date of Birth (MM/DD/YYYY) * / /
         Social Security Number * - -

  Date of Birth (MM/DD/YYYY) * / /  

         Social Security Number * - -

By checking this box and providing my social security number, I certify that I am at least 18 years of age, acknowledge that I have read this entire agreement, the Limited Power of Attorney and the Disclosure Statement, and give my electronic signature for Commonwealth Credit Repair to perform the aforemenetioned work on my behalf.





Commonwealth Credit Repair, Inc.
47 Pleasant Street
Worcester, MA 01609

Tel: 508-755-1996
Toll Free: 1-800-682-2919
Fax: 508-792-1462


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