BrightPoint
Funding Application
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Service Needed
*
Select Option
Credit Repair
Flexible Funding
Both
If both, PrivacyGuard login required
Do you have a PrivacyGuard login?
*
Select Answer
Yes
No
If no, please visit www.privacyguard.com and sign up for login information
PrivacyGuard Login Information
Username/Email
Password
How's your credit?
*
Select Answer
Very Poor 450-550
Poor 550-650
Fair 650-700
Good 700-750
Very Good 750-850
Credit Score (if available)
Do you currently use any credit monitoring site?
*
Select Answer
Yes
No
Credit Monitoring Site (if any)
Login Information (if available)
Credit Report (if available)
Browse Files
Cancel
of
Desired Funding Amount
*
Select Amount
$25k-$50k
$50k-$100k
$100k-$200k
$200k or more
Specific Amount (optional)
Funding Purpose (optional)
Submit
Should be Empty: