Client Intake Form

Intake Form for New Credit Clients
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
1. Are you currently in credit repair?*

YesNo
2. Have you ever been in credit repair?*

YesNo
If so, how long has it been?
3. Are you currently in bankruptcy?*

YesNo
4. Have you ever filed for bankruptcy?*

YesNo
If so, which one, 7 or 13?
5. Do you have a credit monitoring service?*

YesNo
6. Do you know your current FICO Score?*

YesNo
7. Do you have a 620 or below?*

YesNo
8. If you are currently renting a home or apartment, are you reporting your rent payments to increase your credit score?*

YesNoI do not rent
How many years have you been renting in your current location?
9. Do you have a credit card?*

YesNo
10. What would you like your credit score to be?*
11. What is your end goal for improving your credit?*

Buy A HouseBuy A CarBetter CreditStarting A BusinessOther
12. How would you like to be contacted?*

Phone CallZoom Meeting
Should be Empty:

Intake Form for New Credit Clients