M-Powerment Solutions Client Intake Form

M-Powerment Solutions Client Intake Form
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Who referred you?*

First NameLast Name
Please select the range your credit score is in?*
Please select a range
Do you have Credit Karma or any other credit monitoring service?*
Credit Karma, Experian, Credit Sesame, NerdWallet, etc.
What's currently negatively affecting your credit?*
Medical Bills, Student Loans, Collections, Charge Offs, Lack of Credit, High Debt, etc.
Do you have a Bankruptcy or Repossession on your credit report?*
What are your goals for your credit?*
Buy a home, buy a new car, insurance, new job, etc.
Do you have a open credit card account?*

Yes, but just oneYes I have multiple credit cardsNo but I would like more information on how to get pre-approved for a secure credit card
Which service(s) are you interested in?*

Text & Email Credit Monitoring AlertsPersonalized Guide to Building Credit3-Bureau Monthly Credit ReportsAccess to Educational ContentFinancial Coaching & Debt AnalysisCredit Builder Loan Tools180 Day Money Back GuaranteeDispute Letters Mailed For You to All 3 Credit BureausUnlimited Disputes to All 3 Credit BureausHard Inquiry RemovalLawyers to Fight Against Collection AgenciesTrust ProgramsSecured Credit CardRent Reportering (Use Rent Payments To Increase Credit Score)Budgeting/Debt Payoff EducationSmart Credit Monitoring App (View all scores: credit score, auto score, hiring index score, and insurance scoreEntrepreneur Success KitMerchant Services (Payment processing systems for your business)Home Buyer ProgramPersonal LoansBusiness LoansBusiness CreditTax PreparationIdentity Theft ProtectionTravel Discounts and PerksCustomer Referral Program
Would you rather work with a Credit Coach with done-for-you services or would you like to be provided the software to do it yourself?*

Credit CoachDIY
Do you know anyone else who could benefit from these services?*

YesNo
Referral #1

First NameLast Name
Referral's Phone Number

Area CodePhone Number
Referral's Email
example@example.com
Referral #2

First NameLast Name
Referral #2 Phone Number

Area CodePhone Number
Referral #2 Email
example@example.com
If you could improve your credit score while earning some additional income would you want to receive that information?*

YesNo
Are you a business owner?*
Would you like to learn more about business credit?*
Are you a Homeowner?*
Have you heard about the benefits of putting solar on your home? It can lower your monthly energy payment, save tens of thousands of dollars, and increase the value of your home with absolutely nothing out of your pocket. The federal government is even giving people 30% of the cost of the system as a tax credit. Would you be open to learning more about this?*
How would you like us to contact you?*

CallText MessageEmailFacebook/Instagram MessengerZoom Meeting
Appointment
Thank you for submitting your Client Intake Form for your Free Credit Consultation. You will now be redirected to a quick video regarding the services that we offer and the value we will be able to add to you and your family.

We have helped thousands of clients remove questionable negative items, including:

Collections, Late Payments, Foreclosures, Charge Offs, Bankruptcies, Judgments, Repossessions, Liens, Inquiries, and more. We hope to do the same for you!
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