Client Intake Sheet: Credit Repair Services
CLIENT INFORMATION
Name
First Name
Last Name
Date of Birth
Social Security Number
Contact Number
Email Address
Mailing Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse/Co-Applicant Information (if Applicable)
Name
First Name
Last Name
Date of Birth
Social Security Number
Contact Number
Financial Information
Current Credit Score (if known)
Income Sources
Monthly Income
Monthly Expenses
Outstanding Debts (Specify creditor names, balances, and interest rates)
Report Information
Have you obtained a recent credit report? (YES/NO)
If YES, attach a copy
If NO, we can help you obtain one
Goals and Concerns
What are your credit repair goals?
Do you have any specific concerns or items you'd like to dispute on your credit report?
Previous Credit Repair History
Have you used credit repair services before? (YES/NO)
If YES, please provide details
Authorization and Agreement
I authorize Xpress Tax & Biz Solutions LLC to access my credit reports and represent me in credit repair activities. I understand that results may vary and that credit repair is a collaborative effort.
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
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