Personal Credit Prequalification Questionnaire
Helping You Build Strong Credit and Financial Freedom
Personal Information
Section 1:
Full Name:
*
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Date
Social Security Number (optional):
Email Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address:
*
example@example.com
Preferred Contact Method:
*
Phone
Email
Text
Credit Profile & Financial Health
Section 2:
What is your current credit score range?
*
Below 500
500 – 579
580 – 669
670 – 739
740 – 799
800+
Do you know of any derogatory marks on your credit report? (Check all that apply)
*
Late Payments
Collections
Charge-Offs
Bankruptcies
Judgments/Liens
None
What’s your biggest challenge with credit?
*
Low Score
High Debt
No Credit History
Errors on Credit Report
Other
Have you worked with a credit repair company before?
*
Yes
No
Are you actively monitoring your credit?
*
Yes
No
What is your short-term credit goal?
*
Buy a Home
Buy a Car
Qualify for Credit Cards/Loans
Reduce Debt
Improve Score for Business Credit
Other
Budget & Financial Discipline
Section 3:
What is your current monthly income?
*
What are your total monthly expenses?
*
Do you currently have a budget in place?
*
Yes
No
How would you rate your financial discipline?
*
Excellent
Good
Fair
Poor
We offer 3 Month 6 Month & 12 month plans which are you interested in.This includes onboarding and financial assessment to help you become debt free.Services start at $500 & Up
*
We also Accept :
*
Klarna
Afterpay
Affirm
Do you have any outstanding debts in collections?
*
Yes
No
Do you have an emergency fund covering 3–6 months of expenses?
*
Yes
No
Readiness to Invest in Yourself
Section 4:
How important is improving your credit to you?
*
Extremely Important
Important
Somewhat Important
Not Important
How soon are you ready to start improving your credit?
*
Immediately
Within 1 Month
3–6 Months
Just Exploring Options
Do you plan to make any major financial decisions in the next 6–12 months?
*
Yes
No
If Yes, Explain:
*
Are you willing to commit to improving your credit with professional help?
*
Yes
No
Would you like to schedule a free consultation to discuss your options?
*
Yes
No
Financing & Payment Options
Section 5:
Would you like to explore 0% interest financing for your credit services?
*
Yes
No
Preferred Payment Method:
*
Credit/Debit Card
Bank Transfer
Financing
Would you be open to a customized payment plan?
*
Yes
No
Authorization & Consent
Section 6:
I authorize Bright Beginnings Financial to contact me regarding credit repair services and understand that my information will be kept confidential.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: