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QUESTIONNAIRE

CREDIT REPAIR + BANKING RESTORATION

Date Of Birth
Are you a member or former member of the U.S Armed Forces (active, reserve, or National Guard)?
Yes
No

Address*

What was your marital status on December 31, 2023?
Single
Married
Divorced
Legally Separated
Widowed
Have You Used A Credit Repair Service Before?
Yes
No
Are you struggling to qualify for any of the following? (select all that apply):

We need a 3 bureau credit report in order to give you an estimate on the cost to remove the negative items from your credit report. Click the link below to receive your 3 bureau credit report for only $1. Download the credit report on a laptop or computer which you will submit on the following page.


$1 CREDIT REPORT CLICK HERE

Do You Have The Most RECENT copy of your CHEXSYSTEMS Consumer Disclosure Report?
Yes
No, Not Yet
Do You Have The Most RECENT copy of your EARLY WARNING Consumer Disclosure Report?
Yes
No, Not Yet

POWER OF ATTORNEY - AGREEMENT

By signing this, I hereby grant my full consent and authorization, appointing Blui.Ink, LLC ‘doing business as “BLUI.INK Credit Blitz”’ as my Agent (Attorney-in-Fact) with limited power and authority to act on my behalf, as specified below.

  1. Prepare, draft, electronically sign, transmit, dispatch, or lodge documents with any Credit Reporting Agency, Creditor, Collection Agency, Government Taxing Agency, or any other relevant party for the following purposes:

  • Prepare, sign, and submit documents and disputes to any credit reporting agencies via mail, fax, or online channels.

  • Obtain information or documents from any creditor, its agencies, or taxing agencies, both State and Federal.

  • Exercise my rights under the Fair Credit Reporting Act, Fair and Accurate Credit Transaction Act, Health Insurance Portability and Accountability Act, and Fair Credit Billing Act.


I hereby authorize my Agent to undertake all necessary or advisable actions regarding the aforementioned powers, as fully as I could if personally present and acting.

This Power of Attorney is to be interpreted as a Special Use and/or Limited Power of Attorney. The enumeration of specific powers aims to restrict and delimit the powers granted herein. This Power of Attorney remains unaffected by any subsequent disability or incapacity of the principal. My Agent shall not be held liable for any loss resulting from a judgment error made in good faith, nor for willful misconduct or failure to act in good faith while acting under this Power of Attorney. A Successor Agent shall not be held liable for the acts of a prior Agent. I authorize my Agent to indemnify and hold harmless any third party who accepts and acts under this document on my behalf. This Power of Attorney takes effect immediately and shall remain effective until revoked by written notice to my agent.

Date
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