Credit Repair Client Registration Form
Fill out this form in its entirety. If you have any questions, be sure to contact us.
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about us?
*
Please Select
Tax Company
Newspaper
Internet
Magazine
Other
Explain your credit situation and the goals you're trying to accomplish with credit repair.
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Create & enter login for Identity IQ, Credit Score Hero, OR My Free Score Login Credentials
*
If you do not, have an Identity IQ, please go to IdentityIQ.com to create one, https://www.creditheroscore.com/ OR https://myfreescorenow.com/. This will allow us to get your credit report and monitor it for the best results.
Create & enter login for Consumer Finance - https://portal.consumerfinance.gov
*
Upload a Photo of Your Social Security Card
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a Photo of Your ID
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload a Photo of a Utility Bill to show proof of address
*
Browse Files
Drag and drop files here
Choose a file
If you don't have a utility bill, let me know.
Cancel
of
Equifax Login, if you have it
*
Please give reference of any two people whom you feel may need credit repair:
Rows
Full Name
Address
Contact Number
1
2
Please sign your full name below. This confirms you would like to start the process of repairing your credit and you authorize Porterie Tax Solutions to begin that process for you.
*
Submit
Should be Empty: