Client Intake Form
Joel Marcelin Ph:(404) 432-2383 J.Marcelin@SZLGlobalGroup.com
Personal Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
Postal / Zip Code
What made you reach out me ? Why Now?
What is your overall goals with the next 12 months?
Credit Information
Are you a small business owner?
Yes
No
What's your FICO Credit Score?
350- 450
450-550
550-650
650-700
700-850
When was it last viewed?
Have you ever File Bankruptcy in the past 7yrs?
Yes
No
Which of the following do you currently have on your credit report?
Late Payments
Collections
Child Support
Tax Liens
Charge Off Accounts
Bankruptcy
Medical Bills
Repossession
Court Judgment
Identify Theft/Fraud
What Major Purchases are you planning to make in the next 12 months?
Purchase/Refinance a Car
Purchase/ Refinance a Home
Apply for a Business Loan
Applying for Student Loans
Lease a New Apartment
Other
Submit
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