2. Once the 5 day right to cancel period has passed, we will begin investigating and repairing your credit profile.

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1 IMPORTANT: Please take a few minutes to review our process. Thank you for choosing Heartland Credit Restoration Services. Our goal is to help you build a positive credit profile. It is very important to pay attention during this program. We will be setting up a personal interview with you to begin as soon as we receive your application in our office. Please sign and date the forms where indicated. 1. Fax the forms back to when completed, or mail to: Heartland Credit Restoration Inc Blairsferry Crossing Suite B Hiawatha, IA Once the 5 day right to cancel period has passed, we will begin investigating and repairing your credit profile. 3. Once disputed, creditors have days in which to verify the debt to each of the 3 credit bureaus. You will receive information in the mail from the 3 bureaus advising you of the results. This information MUST be returned to our office as soon as possible to complete the process! *** PLEASE INCLUDE TWO FORMS OF PAYMENT ON THE PREAUTHORIZED TRANSFER AGREEMENT FORM (Checking, Savings, Debit Card, Credit Card) *** PLEASE INCLUDE COPIES OF THE FOLLOWING DOCUMENTS: STATE ISSUED DRIVERS LICENSE SOCIAL SECURITY CARD UTILITY BILL / INSURANCE STATEMENT/BANK STATEMENT WITH YOUR NAME AND CURRENT ADDRESS I certify that all information provided to Heartland Credit Restoration including my name, address, credit reports, credit accounts, payment source, and any other pertinent information is true and correct to the best of my knowledge. X Printed X Printed 1 of 9

2 CREDIT REPAIR SERVICE APPLICATION Applicant: First _ Middle _ Last _ Date of Birth Social Security Number Home Number Best time to contact you _ Work Number OK to call at work Y or N (circle one) Cell Number Address _ Street Address City State Zip Previous Address City State Zip Co-Applicant: First _ Middle _ Last _ Date of Birth Social Security Number Home Number Best time to contact you _ Work Number OK to call at work Y or N (circle one) Cell Number Address _ Street Address City State Zip Previous Address City State Zip I hereby certify that the information included above is true and correct to the best of my knowledge. I have also received a copy of the Notice of Cancellation. Applicant signature Date Co-Applicant signature _ Date 2 of 9

3 CONTRACT AND DISCLOSURE STATEMENT This contract is between (herein referred to as client ) and Heartland Credit Restoration, Inc. as a credit services organization which will provide the following services to the client: 1. Services to be provided: In exchange for the agreement below, Heartland Credit Restoration, Inc. will perform as follows. Heartland Credit Restoration shall not charge or collect a fee until such services have been performed in full. I. Initial services: Upon receiving a signed contract from the client, and prior to beginning Heartland Credit Restoration Monthly Maintenance Service, Heartland Credit Restoration will: A. Answer any additional questions regarding credit reports and the credit repair process. B. Provide Client documentation on how credit scores are calculated, and how credit scores impact credit determinations and other decisions. C. Provide documentation that explains the process Heartland Credit Restoration takes to communicate with credit bureaus, creditors, collection firms, and other in order to obtain an accurate credit profile. D. Summarize common misunderstanding consumers have regarding items on their credit reports. E. Help assist Client in either purchasing a credit report or assist in pulling a free report though a credit report provider. F. Examine and review Client s credit reports. G. Answer any questions that Client may have as they identify potential credit report errors or inaccuracies. H. Compile background information and documentation needed for communication and correspondence with credit bureaus, creditors, collection firms and others. I. Confirm Client directive to dispute items designated by Client as lawfully subject to dispute. J. Advice Client of his/her rights according to the federal Fair Credit Reporting Act. K. Prepare and send correspondence in Client s name and on Client s behalf disputing designated inaccurate items appearing on the Client s credit report. II. Monthly Maintenance Services: Upon completing above services, Heartland Credit Restoration, Inc. will perform one or more of the following services on a monthly basis for a total of 5(five) months. Heartland Credit Restoration, Inc. shall not charge or collect such fee until monthly services have been performed in full. A. Correspondence with one or more creditor, collection agency, and or credit bureau via written, electronic, and /or verbal communication regarding audited/disputed items on Client s credit reports. B. Analyze client-provided investigation results or communicate information received by Client related to one or more disputed items and respond if needed on Client s behalf. C. Status update call with Client to discuss program D. Status update ed monthly on progress E. Status update to Client s referral source (if applicable) via and or verbal communication. III. Cost of services: A. Initial Setup and Services: Client agrees to pay $450 for a single person or $700 for a couple after Heartland Credit Restoration, Inc. fully completes the services listed in section I (Initial Services). Heartland Credit Restoration will complete these services in full by day thirty(30th) day from the date of this contract. B. Monthly Maintenance Services: $90 per month will be billed every thirty(30) days from the original day of signing, with such payment only collected after Heartland Credit Restoration Monthly Maintenance Services have been fully performed as outlined in section II (Monthly Maintenance Services). IV. Heartland Credit Restoration is under no obligation to perform any services for Clients and will suspend all further work on Client s matter if scheduled payment agreement is not satisfied. *Heartland Credit Restoration, Inc. will charge and collect for no more than five (5) months of the Monthly Maintenance Services. 2. BOND INFORMATION: The client is hereby notified of their right to proceed against the bond # of which has been purchased by Heartland Credit Restoration, Inc. The name and address of the surety company which issued the bond is as follows: 3 of 9

4 North American Insurance Specialty Insurance Company #600 Elm Street Manchester, NH Limited Power of Attorney: I. Client authorizes Heartland Credit Restoration, Inc. to challenge on Client s behalf information appearing in the Client s credit reports that the Client believes is inaccurate and client authorizes Heartland Credit Restoration, Inc to exchange consumer credit information concerning the client with credit reporting agencies and the client s creditors. Included but not limited to signing my name on all documents written on my behalf as my agent for the purpose of disputing inaccurate, erroneous, and obsolete credit information held on my credit report by credit reporting agencies. Client agrees to hold Heartland Credit Restoration, Inc. and its principals harmless as a result of investigating items on my credit. This Limited Power of Attorney is given to Heartland Credit Restoration Inc. in compliance with section 611 of the Federal Fair Credit Reporting Act. Initials 4. Personal Information Disclosures: I. Heartland Credit Restoration, Inc. will maintain Client s personal information in confidence. Client s personal information will not be sold to any marketing firms or any other agencies at any time. Heartland Credit Restoration may however, communicate status updates to the original person(s) authorized by the client to release information to Heartland Credit Restoration, Inc. The confidential provisions of this agreement shall remain in full force and effect after the termination of the agreement. 5. Governing Law and Venue: I. This agreement shall be governed by the laws of the State of Iowa. Should it be necessary to enforce provisions of the agreement, then Heartland Credit Restoration, Inc. shall be entitled to recover the reasonable costs of enforcement including attorney s fees, the parties further agree that the Iowa District Court for Linn County, Iowa, shall have exclusive jurisdiction over any dispute arising under this agreement. 6. CORPORATION ADDRESS/Agent for Service of process: II. The address for Heartland Credit Restoration, Inc. is 2205 Blairsferry Crossing, Suite B Hiawatha, IA Andrew Yamilkoski, C/O Heartland Credit Restoration, Inc. 7. ACTIONS REQUIRED OF CLIENT: I. Client agrees to obtain a copy of the Client s credit report from the CRA and to provide Heartland Credit Restoration, Inc. with a complete copy of Client s credit reports received from the CRA in order for Heartland Credit Restoration, Inc. to begin credit repair services on behalf of Client. II. Client agrees to pay the fee required by the CRA to obtain Client s credit reports, if applicable. III. Client agrees to provide Heartland Credit Restoration, Inc. a complete copy of credit reports and any and all correspondence Client receives from the CRA or Creditors during the investigation process within 5 business days of the date Client receives such correspondence from the CRA or Creditor. Failure to execute either or both of the aforementioned tasks will not affect the requirement of full payment for completed services at the end of each calendar month. I hereby certify that all information provided by me/us to Heartland Credit Restoration is true and correct to the best of my knowledge and therefore hold harmless Heartland Credit Restoration from any damages resulting from said information. Executed this day of, 20. Applicant signature _ Co-Applicant signature YOU MAY CANCEL THIS CONTRACT WITHOUT PENALTY OR OBLIGATION AT ANY TIME BEFORE MIDNIGHT OF THE 5 th BUSINESS DAY AFTER THE DATE ON WHICH YOU SIGNED THE CONTRACT. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. 4 of 9

5 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 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 Federal Trade Commission Washington, D.C I/we confirm that fact that I/we agree and understand what is being signed, and acknowledge that I/we have received a copy of the Consumer Credit File Rights. X Date X Date A telefaxed copy of this agreement shall be considered an original. 5 of 9

6 NOTICE OF RIGHT TO CANCEL Client (s) You may cancel this contract without any penalty or obligation within five (5) days after the date the contract is signed. If you cancel, any payment made by you under this contract will be returned within ten (10) days after the date of receipt by Heartland Credit Restoration, Inc. HOW TO CANCEL: To cancel this contract, mail or deliver a signed and dated copy of this cancellation notice or any other written notice to: Heartland Credit Restoration, Inc Blairsferry Crossing Suite B Hiawatha, IA Phone Fax This written notice must be delivered no later than midnight of, 20. I WISH TO CANCEL THE AFOREMENTIONED CONTRACT WITH HEARTLAND CREDIT RESTORATION, INC. Date Client Signature I/We acknowledge receipt of a copy of this Notice of Right to Cancel. Both the Client and Co-Applicant have the right to cancel. The exercise of this right by either shall be effective as to both. X Printed X Printed 6 of 9

7 NOTICE OF RIGHT TO CANCEL Client (s) You may cancel this contract without any penalty or obligation within five (5) days after the date the contract is signed. If you cancel, any payment made by you under this contract will be returned within ten (10) days after the date of receipt by Heartland Credit Restoration, Inc. HOW TO CANCEL: To cancel this contract, mail or deliver a signed and dated copy of this cancellation notice or any other written notice to: Heartland Credit Restoration, Inc Blairsferry Crossing Suite B Hiawatha, IA Phone Fax This written notice must be delivered no later than midnight of, 20. I WISH TO CANCEL THE AFOREMENTIONED CONTRACT WITH HEARTLAND CREDIT RESTORATION, INC. Date Client Signature I/We acknowledge receipt of a copy of this Notice of Right to Cancel. Both the Client and Co-Applicant have the right to cancel. The exercise of this right by either shall be effective as to both. X Printed X Printed 7 of 9

8 Authorization Agreement for Preauthorized Transfers Client Name(s) I (we) hereby authorize Heartland Credit Restoration, Inc. to initiate debit entries to my (our) checking or savings account indicated below at the depository named below, hereinafter referred to as Bank, or to apply such charges to the credit card or debit card indicated below, for the amounts indicated in my contract with Heartland Credit Restoration, Inc. CHECKING ACCOUNT INFORMATION (if savings please circle) SAVINGS: Bank Name Branch Address Phone Number _ City State _ Zip Routing Number Account Number Debit Card Number Exp Date Please attach a voided check CREDIT CARD INFORMATION Credit (or Debit) Card Number Exp Date _ ** Must have both Checking Acct OR Debit information AND Credit Card information ** This authorization is to remain in full force and effect until Heartland Credit Restoration, Inc. has received a thirty day written notice prior to the termination date from me (us) as to afford Heartland Credit Restoration, Inc. and the Bank a reasonable opportunity to act on it. X Printed X Printed Date Note: All written debit authorizations must provide that the receiver may revoke the authorization only by notifying the originator in the manner specified in the authorization. 8 of 9

9 Acknowledgment to optimize maximum benefit to your credit profile during our program: I will pay all of my bills on time (nothing past 30 days of due date) during this program. I will send all original documents that I receive from my creditors, collection agencies, and the credit bureaus, or any information from each individual bureau after making copies for individual records to Heartland Credit Restoration. I understand that there are monthly service payments of $90.00 in addition to the initial services provided. Heartland Credit Restoration Inc. shall not charge or collect for any service until such services have been provided in full. I understand that while in Heartland Credit Restoration Inc. program it may be necessary to re-establish a trade-line or credit to improve my scores. If I have been advised by my provided credit tech to re-establish credit, I will take the necessary steps to do so. I however can pick the creditor of choice. I understand that changes to scheduled payments will require Heartland Credit Restoration Inc. ownership approval and at least three (3) business days notice prior to any changes of scheduled payment. There will be a $20.00 charge for all payment plan changes. I understand that while participating in Heartland Credit Restoration Inc. s program, I will receive audit / investigation /delay results in the mail. Furthermore I understand that these investigative results will NOT have updated credit scores. If I would like to track the progress of my credit score, Heartland Credit Restoration can recommend a reputable monitoring firm or web-site to purchase credit scores. I understand that if I move residences that I will notify Heartland Credit Restoration Inc. within five (5) business days and provide them with updated proof of new residence. I also understand that this move during the program could delay my receiving of investigative results. I understand that Heartland Credit Restoration cannot guarantee the removal of any specific item from my credit profile. I understand that Heartland Credit Restoration will help me acquire a copy of a report, they do not offer financing and therefore can t provide a credit report with scores other than through my purchase of a report directly sold through a credit reseller. Client Signature: Date: Printed Name: 9 of 9

10 ATTN EXPERIAN, PLEASE READ!!! The enclosed dispute letter is authentic and authorized by me. Please do not send out your suspicious request letter and delay the process of verifying and correcting inaccurate information on my credit report. Along with the dispute letter, I am also including the identification and proof of address information that is requested by your company for verification. This request to investigate and correct inaccurate and erroneous information on my Experian credit report was initiated by me and I am requesting that you investigate my requests per the FTC s consumer protection laws and respond back to me via US Mail with the results of your investigation. Regards, Sign Name Print Name

11 ATTN EXPERIAN, PLEASE READ!!! The enclosed dispute letter is authentic and authorized by me. Please do not send out your suspicious request letter and delay the process of verifying and correcting inaccurate information on my credit report. Along with the dispute letter, I am also including the identification and proof of address information that is requested by your company for verification. This request to investigate and correct inaccurate and erroneous information on my Experian credit report was initiated by me and I am requesting that you investigate my requests per the FTC s consumer protection laws and respond back to me via US Mail with the results of your investigation. Regards, Sign Name Print Name

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