Client Intake Form
Section 1: Personal Information
Name
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
Email Address
Phone Number
Current Address
Section 2: Credit and Financial Situation
Do you have any current financial issues, such as tax liens or bankruptcies?
Yes
No
If yes to any tax liens or bankruptcies, please provide a brief description.
Are you trying to make a big purchase (e.g., home, car, etc.) in the near future?
YES
NO
If yes, what big purchase are you trying to make and when do you plan to make this purchase?
How quickly do you need your credit repaired?
1-3 Months
4-6 Months
No specific timeline, just want it done right
Have you worked with a credit repair company before?
Yes
No
If yes, when was this and what was your experience?
Are you currently struggling with bills or other debts? If yes, briefly explain your situation.
Section 3: Commitment and Expectations
Your Note
Are you currently struggling with bills or other debts?
Yes
No
Are you comfortable with possibly waiting 6-9 months to complete this program? **(May be completed sooner )**
Yes
No
Do you have the ability to make regular payments for credit-related costs (e.g., payments toward valid debts, monthly payment for this credit program)?
Yes
No
Are you willing to provide the necessary documents (e.g., identification, credit reports, proof of income) to begin the credit repair process?
Yes
No
Have you actively monitored your credit score in the past year?
Yes, regularly
Yes, occasionally
No, not at all
AM Financial Service require our clients to utilize Experian.com, MyEquifax.com and Transunion.com to access their reports. Please submit your login for these 3 sites (create a FREE account if don't have).
If cant access the monitoring sites above then can upload your Experian, Equifax and Transunion Credit reports from annualcreditreport.com in PDF Format Only
Browse Files
Drag and drop files here
Choose a file
Please include any attachments (e.g., logo, mission statement, annual report, etc.) that would help us better understand your company's needs.
Cancel
of
How would you describe your financial goal for this credit repair service?
Increase credit score
Remove negative items
Settle debts
Prepare for a major purchase
General financial improvement
Are you committed to following a budget and adjusting financial habits during this program?
Yes
No
Not sure, would need guidance
Section 4: Financial Background & History
Do you have any outstanding collections or charge-offs on your credit report?
Yes
No
If yes, please estimate the total amount of collections.
Are there any ongoing disputes regarding debts (e.g., medical bills, credit card charges)?
Yes
No
If yes, please describe briefly.
Section 5: Employment and Income
What is your current employment status?
Employed full-time
Employed part-time
Self-employed
Unemployed
Retired
Student
Do you expect your income to change in the next 6-12 months?
Increase
Decrease
Stay the same
Section 6: Payment Plan & Budget Considerations
Do you have a current monthly budget that you follow?
Yes
No
Sometimes
What is the monthly budget you can comfortably allocate for credit repair and related costs?
Any additional information you think we should know about your financial situation?
Section 7: Understanding of the Process
Have you reviewed the typical steps involved in credit repair, including your responsibilities?
Yes I understand the steps
No, I need further information
Other
Do you understand that results may vary based on individual credit situations and are NOT GUARANTEED?
Yes
No
Section 8: Consent and Additional Information
Do you consent to having CTRL+ YOU contact you via email or phone (calls or texts) regarding the credit repair process?
Yes
No
Are you willing to stay actively involved, respond to inquiries, and provide any necessary documents during the program?
Yes
No
Do you agree to abide by all terms and conditions once your credit repair services begin?
Yes
No
How did you hear about CTRL+ YOU?
Internet search
Social Media
Friend or family member
Advertisement
Privacy Disclaimer
We value your privacy and are committed to protecting your personal information. All the information you provide in this form will be kept strictly confidential and will only be used to evaluate your eligibility for our credit repair services. Your data will never be sold or shared with third parties without your explicit consent, except as required by law. We implement appropriate measures to ensure the security of your information, protecting it against unauthorized access, alteration, or misuse.
By signing below, you acknowledge that credit repair is a process and requires cooperation and patience.
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: