Intake Form for New Credit Clients
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
1. Are you currently in credit repair?
*
Yes
No
2. Have you ever been in credit repair?
*
Yes
No
If so, how long has it been?
3. Are you currently in bankruptcy?
*
Yes
No
4. Have you ever filed for bankruptcy?
*
Yes
No
If so, which one, 7 or 13?
5. Do you have a credit monitoring service?
*
Yes
No
6. Do you know your current FICO Score?
*
Yes
No
7. Do you have a 620 or below?
*
Yes
No
8. If you are currently renting a home or apartment, are you reporting your rent payments to increase your credit score?
*
Yes
No
I do not rent
How many years have you been renting in your current location?
Please Select
Less than 1
1
2
3
4 or more
9. Do you have a credit card?
*
Yes
No
10. What would you like your credit score to be?
*
11. What is your end goal for improving your credit?
*
Buy A House
Buy A Car
Better Credit
Starting A Business
Other
12. How would you like to be contacted?
*
Phone Call
Zoom Meeting
Submit
Should be Empty: