Cohen Financial Group
             Your Information
First Name:
Last name:
Billing  Address:
Zip:
State:
City:
Phone Number:
Email Address:
Shipping Address:
City:
 State:
 Zip:
Credit Card Information
Card:
Card Number:
C V V:
Exp. Date:
 Service
Product or Service Name:
Shipping Method:
Cost:
Total:
I authorize Cohen Financial Group to charge me for the above total.
I further affirm that the name and personal information provided on this form are true and
correct.


_____________________________________________________________________
Note: Please complete all blocks. Please indicate the Product name. Shipping Method for
Credit Repair kit or indicated Report., such as Appraisal Fee. Include shipping fee with
total. Call 1-800-928-6154 for Help.
               Credit Card Order
Fee Chart


                                     
5501     Residential Appraisal:                 $380
5502     Appraisal Rush Fee                     $100
5503     Commercial Appraisal                $3500- $5500
5504     Commercial Appraisal Rush Fee:$1200
5505     Credit Line Application Fee        $545
5506     Line of Credit Consulting Fee      $650
5507     Commercial Hedge Fund Fees    $5000
5508     Tri-Merge Credit Report               $125
5509      Rapid Rescore                            $225
5510      Wire Fee                                     $50
5511      Standard Processing Fee            $995
5512      Broker Fee                                   $1295
5513      Hard Money Lender Fees            $5000
5514      Foreclosure Bailout Fee              $1295
534        Credit Repair Kit                          $39
535        Credit Repair Kit-Increase Fico   $39
Item    Service             Price