Name*

Smart Credit Username:*

Smart Credit Password:*

Phone Number*

Social Security Number*

Date of Birth*

Your Personal Email*

Address*

City*

State*

Postal (Zip) Code*

Have you lived at this address for 2 years or longer?*

Previous address if less than 2 years:

Based on my credit report, I believe I may be the target of identity theft. The items I went through with your analyst may be in question to me. Please list all the items that we discussed on my behalf pursuant to our underlying agreement.*

Have you ever used a credit, debit card or shared your personal information with any of the following companies at any of their locations? – Macy’s, Sears, Home Depot, Verizon, Kmart, Wendy’s, Delta Airlines, Michaels, Best Buy, Landry’s, Saks Fifth Avenue, JP Morgan Chase, Lord & Taylor, Facebook Account, Panera, Ebay, Forever 21, Orbitz, Sonic, Chili’s Restaurants, WholeFoods, Uber, Arby’s, Target Stores, Walmart, Marriott, Quest Diagnostics, Experian or Equifax?*

Have you ever been employed by the US Government?*

Have you ever received any government benefits of any kind?*

Are you a veteran?*

Please Scan and upload a photo of your current, valid state Drivers’ License or a Government Issued Photo ID* (JPG and PDF ONLY)

Please Scan and upload a recent utility bill or bank statement showing your name and current residence address – must be less than 60 days old.* (JPG and PDF ONLY)

By signing below, you agree to our service agreement terms and conditions, agree to be truthful, and you understand that no promises have been made by Us, DPS Resource or any of our agents to you outside of this Agreement. You also agree to a limited Power of Attorney to carry out the requested services.
A generated Service Agreement and Limited Power of Attorney will be generated and emailed to you upon successful completion and submission of this form.
Use your Mouse, Mousepad, Touch Screen to Sign Below and Click on Submit.*