Nex Gen Wealth Group
Client Intake Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Instagram Name
*
What is your current credit score range?
*
Below 500
500-599
600-699
700+
Which credit bureaus have negative items?
*
Please Select
Transunion
Experian
Equifax
All 3
I Don't Know
What negative accounts do you need removed?
*
Late Payments
Collections
Charge-Offs
Reposessions
Bankruptcies
Evictions
Hard Inquiries
Chexsystems/Early Warning Services
Child Support
Medical Bills
Student Loans
Other
Do you currently have any open credit cards?
*
Yes
No
Have you worked with a credit repair company before?
*
Yes
No
What are your main goals with better credit? (Select all that apply)
*
Buy A House
Buy/Finance A Car
Get Business Funding
Increase Credit Limits
Get New Credit Cards
Other
Are you ready to invest in your credit repair today?
*
Yes, I am payment ready
No, not yet
Yes, but I don't have a bank account to pay
Which package are you most interested in?
*
PLATINUM
24K-GOLD
DIAMOND
COUPLES
NOT SURE YET
By submitting this form, I agree to be contacted by Nex Gen Wealth Group for credit services.
*
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