Impeccable Change Financial Consultation Checklist

IMPECCABLE CHANGE CONSULTATION CHECKLIST

PLEASE COMPLETE PRIOR TO YOUR APPOINTMENT
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name
EMAIL ADDRESS
Phone
Format: (000) 000-0000.
Days Available
Times
1. Are you in a financial crisis that will prevent you from paying your bills over the next 6 months? Y or No? Briefly Explain!
2. Are you currently in Active Bankruptcy? Yes or No?
3. Do you know your credit scores? Yes, or No?
4a. Experian Score
4b.Equifax Score
4c.Transunion Score
5. What have you done to improve your credit/finances? Please be specific
6. What are your plans once you have reached your credit/finance goals?
7. How soon do you want to achieve your credit/finance goals?
8. What do you feel has kept you from obtaining your credit/finance goals?
9. Are you actively in credit repair? Yes, or no?
10. Do you want to repair your credit yourself?
11. Would you like someone to repair your credit or do it for you?
12. Do you have a Business? Yes, or no?
13. Are you interested in starting a business?
14. Do you need help structuring your business to get business credit or funding? Yes OR no?
15. Do you need business credit or funding? Yes, or no?
16. What questions do you have about our services?
Intake Representative blanks Date Time Type a label
Should be Empty: