Credit Consulting Client Intake Form
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First Name
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Last Name
*
Date of Birth
Primary Email
*
Primary Phone
Full Address
Preferred Contact Method
Make a selection
Phone
Email
Text Message
Please explain your primary credit goal or any deadlines you are working toward.
Make a selection
Improve overall credit profile
Prepare to purchase a home
Prepare to purchase or refinance a vehicle
Qualify for business funding
Reduce debt
Address collection accounts
Address charge-offs
Address late payments
Address repossessions
Address student loan reporting
Correct inaccurate personal information
Remove unauthorized inquiries
Identity Theft
Other
Which credit agencies are reporting the items you are concerned about?
Make a selection
Experian
Equifax
TransUnion
Have you previously disputed any of these accounts?
Yes
No
Unsure
If "Yes", Which company(s) did you dispute? When was the dispute submitted? What was the results?
Do you have copies of the dispute letters and results?
Yes
No
Have you received a collection lawsuit or court summons?
Yes
No
Is any creditor currently threatening legal action?
Yes
No
Are your wages or bank accounts being garnished?
Yes
No
Have you filed bankruptcy?
Yes
No
Are you currently represented by an attorney for any of these accounts?
Yes
No
Have you received an eviction judgment or apartment-related court filing?
Yes
No
Have you been a victim of identity theft?
Yes
No
Which service are you currently using to monitor your credit?
Make a selection
AnnualCreditReport.com
Experian
Credit Karma
MyFICO
IdentityIQ
SmartCredit
MyScoreIQ
Other
I do not currently have credit monitoring
Would you like assistance obtaining or uploading your reports? (once your client portal is set up, you will see the option to upload your documents)
Yes
No
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