DM INTAKE FORM

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Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.
Area Code
Phone Number
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Email* This field is required.
example@example.com
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Are you interested in our services or business opportunity?* This field is required.
Services
Business Opportunity
5
Which service would you like to acquire?* This field is required.
Credit Restoration
Credit My Rent
Estate Planning (Will, Trust, and Power of Attorney)
Secured Credit Card
Merchant Processing
Smart Credit Monitoring
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Do you have any questions about this service before you enroll
Yes, I have questions about Credit My Rent.
Yes, I have questions about Will & Trust.
Yes, I have questions about the Secured Credit Card.
Yes, I have questions about Smart Credit
Yes, I have questions about Merchant Payments.
I do not have any questions.
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1. Do you know your current FICO Score?* This field is required.
Yes
No
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2. Do you have a 620 or below?* This field is required.
Yes
No
9
3. Do you have all of the following: Last Will, Living Trust, Health Care Power of Attorney, and a Financial Power of Attorney?* This field is required.
Yes
No
10
4. Do you have all of your personal finance documents and information organized in a place that the appropriate people could easily find it if something were to happen to you?* This field is required.
Yes
No
11
5. Are you aware that identity theft is the fastest growing crime in our country today?* This field is required.
Yes
No
12
6. Do you have some type of identity theft protection system currently in place?* This field is required.
Yes
No
13
7. Do you currently have a budgeting and debt payoff tool or system that helps you pay off your debt most efficiently and enables you to know the exact month and year that you will be debt free?* This field is required.
Yes
No
14
8. If you are currently renting a home or apartment, are you reporting your rent payments to increase your credit score?* This field is required.
Yes
No
I do not rent
15
How many years have you been renting in your current location?* This field is required.
Less than 1
1
2
3
4 or more
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9. Do you have a credit card?* This field is required.
Yes
No
17
Do you have a bankruptcy on your credit profile?
YESNO
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Have you been discharged from your bankruptcy?
YESNO
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Do you have a repossession on your credit profile?
YESNO
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10. Do you have a credit karma account?* This field is required.
Yes
No
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11. If you do not have a credit karma account will you create one? We use credit karma for our consultation.* This field is required.
Yes
No
N/A
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12. What would you like your credit score to be?* This field is required.
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If you could improve your credit score while earning some additional income would you want to receive that information? * This field is required.
YESNO
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13. What is your end goal for improving your credit?* This field is required.
Buy A House
Buy A Car
Better Credit
Starting A Business
Other
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Why are you looking to start a business?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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What attributes do you feel is your strongest asset to assist you in building a business?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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How do you feel you can contribute to a team of individuals who will be working together to build a business?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Are you looking to start a business that you can work full-time or part-time?
Part-Time
Full-Time
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If you were to become a business owner on a part-time basis, approximately how much would you need to make on a monthly basis in order to make this worth your time?* This field is required.
$500 to $1000
$1000 to $1500
$1500 to $2000
$2000 to $2500
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Approximately how many hours could you commit each week to develop that kind of income?* This field is required.
4 to 6
6 to 10
10 to 16
16 to 24
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If we could show you how to develop an income of the amount you selected, working the hours per week that you are committed to, over the course of months that you chose, would you like to receive the information?* This field is required.
Yes
No
32
How would you like to be contacted?* This field is required.
Phone Call
Zoom Meeting
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Please Select Your Appointment Time* This field is required.
34
Thank you for your interest in our services or desire to become a business partner. We value your time therefore you will be redirected to watch a video if you have any questions about certain services such as Estate Planning, Credit My Rent, or Will & Trust. Credit Restoration clients will have a video available to explain our credit restoration package to help you better understand the product. All potential business partners must watch the video after completing your form to access the details of the business and compensation prior to your appointment time.
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