Credit Restoration Intake Form
Let's get you to 'approved.' 🤎Fill this out so I can review your situation BEFORE we talk — that way our call is all strategy, no paperwork. Then book your free consultation on the next page
Personal Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Credit Information
What are you working toward in the next 12 months?
Purchase/Refinance a Home
Purchase/Refinance a Car
Lease a New Apartment
Apply for a Business Loan
Apply for Student Loans
Other
What's your current credit score range?
*
350-450
450-550
550-650
650-700
I haven’t checked
When's your timeline?
0–3 months
3–6 months
6–12 months
Just exploring for now
Have you filed for bankruptcy in the past 7 years?
Yes
No
Which of the following do you currently have on your credit report ?
Collections
Late Payments
Child Support
Tax Liens
Charge Off Accounts
Medical Bills
Court Judgement
Identify Theft/Fraud
Other
Ready to work with me? Pick the option that fits where you are right now.
Please Select
Boss Up Wealth Circle — $97/month** — Done-for-you credit restoration plus education, coaching, and community. Best for: the woman who wants her credit fixed AND the knowledge to keep it that way.
90-Day Credit Reset — $297** — A focused 90-day reset: negatives addressed, profile cleaned up, fresh start. Best for: the woman who needs a reset before the rebuild.
6-Month Access Plan — $497
BEST VALUE — Full credit restoration with funding-readiness prep for a home, car, or major purchase. Best for: the woman with a purchase date in mind who needs her profile positioned before she applies.
If we're a fit, are you in a position to get started this week?
Yes
Not yet - I want a plan for what I am
Want to learn how to build business credit too?
Yes
No - personal credit only for now
Who can I thank for sending you my way?
Please Select
Instagram
Facebook
A friend
A referral partner
Appointment:.
CAN YOU NAME 5 PEOPLE THAT YOU KNOW WHO COULD BENEFIT FROM OUR SERIVES? NAME THEM AND WE WILL SHOW YOU HOW YOU CAN POTENTIALLY GET YOUR SERVICES WAVED STARTING NEXT MONTH.
I understand that credit restoration results vary and no specific score increase, deletion, approval, or outcome can be guaranteed.
Please Select
I understand
Submit
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