New Client Information Form

New Client Information Form

Thank you for taking the time to consider Integrity Credit Consulting for your credit needs. The form below is needed to start your evaluation. Please fill this form completely. If you have any questions, you can contact us at (407) 454-7676 or repair@integrity-credit.com.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Other Names Known By:
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous address if current address is less than 2 years old

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Current Credit Scores (separated by spaces)
Have you pulled your free annual credit report from annualcreditreport.com yet?*

YesNo
According to your credit report, how many of your currently active accounts are past due?

None1 to 34 or moreI don't know
What are some other issues with your credit report? (ex. Collections, Bankruptcy, repossession, late payments, etc)
Which of the following credit report monitoring services do you currently use? (Select all that apply)

Credit KarmaExperian appCredit SesameIdentity IQOtherI don't currently monitor my credit
How would you rate your current knowledge about credit repair and credit maintenance?

Very KnowledgeableSomewhat KnowledgeableLittle to No Knowledge
How do you plan on paying for the services you receive?

Credit/DebitCheckCashApp transfer (Venmo, Paypal, etc.)
When is the best time to contact you for your initial consultation?
How did you hear about us?
What service are you interested in receiving?
prevnext( X )
Collection Removal
A removal of all your collections accounts (maximum of 10 different collectors)

$300.00



Inquiry removal
We remove all invalidated inquiries from your report.

$300.00



400+ to 600+ Club
We bring your score from the 400s to at least the 600s, disputing a combination of items with our dynamic validation process.

$600.00



500+ to 700+ Club
We bring your score from the 500+ to at least the 700s, disputing a combination of items with our dynamic validation process.

$600.00



800+ Club
The most prestigious number! We work hard to bring your score to perfect condition and continuously provide guidance and recommendations to bring your score to the 800s!

$2,000.00



Public Record Removal
A removal of Bankruptcy, Repossession, or Foreclosure

$3,500.00



Total

$0.00
Please upload screenshots of credit scores or copies of credit reports (this will speed up the consultation and process).

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Any additional comments:
I agree to furnish the above-requested information to Integrity Credit Consulting, LLC so that they may begin the process of my credit consulting and credit repair. I further understand that my data will never be sold or distributed to any other person or company and agree with Integrity Credit Consulting, LLC's Privacy Policy.*

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