ERSA SvcOrder Form

REMOVE EVICTIONS.
COM New Order Information Intake Form___/___/2009

Please complete the following form so that we may process your order request.
Personal Information:
Name: ____________________________________________ State of Eviction Residence: ___ Year/Eviction:____
Full Address of Eviction Address: ___________________________________________ City: __________________
Email: ____________________________________________ ( )__________-___________________
I am interested in having the following of your services performed for me:
Tenant-Initiated Eviction Check/Screen Please search as far back as ______ years. I understand and agree to
the fact that this service will search all applicable public records and professional data compilation company
records, viewable by most property management companies, private landlords and others in the business of
renting, leasing and selling properties. I further understand that at the end of this service, I will know definitively
whether any eviction(s) or eviction processes are attached to and/or showing on my rental history record. I agree
to the one-time fee of $10 for this service, payable to E. R. S. A. home of REMOVEEVICTIONS.COM via Creative
Marketing Services or another of their agents.
Eviction Record/Entry Removal Service Please remove the eviction(s) record/entries or entry from my rental
history record. I understand that this service to me includes the removal of clearly related entries or entry on my
credit report which relate directly to the aforementioned eviction(s). I further understand that every legal method
will be utilized in order to ensure the permanent removal of said entries or entry. I understand that the
completion of this service can take a duration of as little as 24-hours for some elements of progression and up to
30-days or longer for the entire process to complete. I agree to pay to E. R. S. A. home of RemoveEvictions.com via
Creative Marketing Services or another of their agents, the total amount of $295 (plus $10 per Extension of Credit
Fee) for the completion of this service. It is my understanding that, although I can opt out of E. R. S. A.’s
convenient payment plan and pay only $250 for one upfront payment in lieu of participating in their Monthly
Payment Program. I choose to participate in E. R. S. A.S.’ CONVENIENT PAYMENT PLAN . I choose the following
payment plan option: PAYMENT SCALE BREAKDOWN
Divide your payments into 3 monthly payments...........Pay only $49.95 today!

Pay only $81.68/month
Plus a $10/month Extension Of Credit Charge
I agree to make timely payments to E. R. S. A. home of REMOVEEVICTIONS.COM via Creative Marketing
Services or another of their agents by the _______of each month for ______ months. TOTAL AMOUNT DUE
TOTAY: $_________________ . Please remit your payment total to us via PAYPAL’S SEND MONEY function to
j_neg@wekanduc.com (Verified Business Users Since 2009)
If you know the Unlawful Detainer Case#(s), please provide them here:
__________________________ ______________________________ ____________________________
An E. R. S. A. representative will be contacting you, shortly. You may contact uss, at: (888)680-4931 Ext. 222
REMOVE EVICTIONS.COM New Order Information Intake Form___/___/2009
Please complete the following form so that we may process your order request.
Please use this attachment form to include more addresses of evictions and/or names under which your evictions
might be affiliated:
















“We appreciate your business and look forward to assisting you, greatly!”
--The staff at E. R. S. A. RemoveEvictions.com
An E. R. S. A. representative will be contacting you, shortly. You may contact uss, at: (888)680-4931 Ext. 222

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REMOVE EVICTIONS.

COM New Order Information Intake Form_/_/2009

Divide your payments into 3 monthly payments...........Pay only $49.95 today!

____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

Name: __________________________________________ State of Eviction Residence: _ Year/Eviction:____

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