ENROLLMENT

Name

First NameLast Name
Last 4 of SSN #*
DATE OF BIRTH*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
QUESTIONNAIRE
What are your financial goals once your credit is repaired?
How soon are you trying to meet these goals?
Do you currently have consistent income? (This is necessary for rebuilding your credit and possible settlement of debt if needed)*

YesNo
Are you up to date and have been on time with your bills for the last 3 months? (If no, please DO NOT ENROLL)*

YesNo
Are you financially able to pay your current bills over the next 3-9 months?*

YesNo
Do you currently have an active bankruptcy?*

YesNo
If yes, when will it be discharged?
Have you ever worked with another credit repair company or tried to repair your own credit in the last 6 months?*

YesNo
If yes, why did you leave/what was the outcome?
Monthly Credit Monitoring is required during the credit repair process for $24.99 (Which is separate from the monthly fee) Are you willing to enroll in this service?*

YesNo
If not, please explain why?
If you were referred by someone, who referred you?
Plan Selection and Payment
Select Your Plan**

My Products

Credit Audit/Document Processing Fee

$87.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Upload State ID

Cancelof
Upload Utility Bill (Phone, Light, Gas, Bank Statement, Insurance Bill ETC

Cancelof
PLEASE REVIEW FORM BEFORE SUBMITTING
*Upon submitting this form, you will be directed to Smart Credit to order your credit report for $1 Trial for 7 days. Once ordered, please email your Username and Password to: info@freelifeconsultinggroup.com
*We are currently not accepting clients from Georgia
*We do not accept clients that are currently in an active Bankruptcy. The bankruptcy must be be discharged or dismissed in order to enroll in our program
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QUESTIONNAIRE