Impeccable Change Financial Consultation Checklist

IMPECCABLE CHANGE CONSULTATION CHECKLIST

PLEASE COMPLETE PRIOR TO YOUR APPOINTMENT
Date

MonthDayYear
Date
Name
EMAIL ADDRESS
Phone
Format: (000) 000-0000.
MTWTFSaSu
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!
YESNO
YESNO
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?
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
YESNO
16. What questions do you have about our services?
Intake Representative blanks Date Time Type a label
Should be Empty: