First Name

Last Name

Address

Street Address

City

State

Country

Postal Code

Phone *

Email *

Preferred method of communication

Phone Call

Text Message

Best time to contact you: *

What is motivating you to fix your credit?

Buying a home

Buying a car

Starting a business

Renting an apartment

Lowering Interest rates

General Credit Improvement

How soon do you want to achieve the goal above?

0-3 Months

3-6 Months

6-12 Months

1-2 years

Do you know your current credit score?

Yes

If yes, what is the approximate score?

Below 500

500–549

550–599

600–649

650–699

700+

Which negative items are showing on your credit report?

Late Payments

Charge Offs

Collections

Medical collections

Repossessions

Foreclosure

Bankruptcy

Identity theft / incorrect accounts

How many negative accounts are on your report?

1-3

4-7

8-12

12 +

Select the credit bureaus that has inaccurate or negative information reporting.

Equifax

Experian

Transunion

Lexis Nexis

All of the above

Any open credit cards, if so how many?

Are you able to make monthly payments toward improving your credit?

Are any accounts currently past due?

Before we can review your credit report, we require:

✔ Completion of this intake form
✔ A credit monitoring report from www.myannualcreditreport.com or MyFICO
✔ A scheduled consultation

Are you willing to provide either prior to scheduling a consultation?

Yes

I understand that:

• Completing this form does not start services
• Credit repair services require a signed agreement and payment
• Results cannot be guaranteed

Would you like to schedule a Credit Review Consultation?

Yes — send me the booking link

Not yet, I just have questions