FixItCredit Repair Intake Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
1. What is your current credit score range?
Below 500
500-579
580-669
670-739
740+
What are the biggest issues on your credit report? (Check all that apply
Late payments
Collections
Repossessions
Student loans
Child support
Charge-offs
Other
Bankruptcy
Which credit bureaus are reporting these issues? (Check all that apply)
Experian
TransUnion
Equifax
Im not sure
What are your credit goals? (Check all that apply)
Buy a house
Get a car
Personal funding
Business funding
Just want a better score
Other
How soon are you looking to improve your credit?
ASAP
In 30 days
In 2-3 Months
Are you ready to invest in fixing your credit today if it’s affordable?
Yes
No
I need more info
Our credit repair service is $500. Are you able to invest in this today?
Yes
No
I’d like an affordable payment plan
Follow up within 1-2 weeks
Would you like a free credit analysis before we get started?
Yes
No
Submit
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