This form is to act as an authorization for USPI attempt to correct delinquent items in my credit reports. USPI will contact the three major credit bureaus on your behalf, Trans Union, CBA and Equifax.
I further authorize USPI to send letters to the credit bureaus on my behalf. I am aware that it can take up to 90 to 120 days to have items corrected or removed from my credit profile if we are successful.
I hereby authorize USPI to review my credit reports and take the appropriate action in regards to derogatory items that may be listed on my credit reports with the three major credit reporting agencies, CBA, Trans Union and Equifax. By placing my signature below I authorize the above.
Signature: __________________________ Witness Signature:____________________________
Date:______________________________
Fill out this form, print, sign and mail to USPI, PO Box 126, Palm Harbor, FL 34682. Include a check or money order for $375.00 payable to USPI.