Intake Form
Thank you for choosing LUZOR Strategies. Please complete the form below so we can accurately review your credit profile and begin the credit restoration process.
Full Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
Last 4 of SSN (Helpful for CRA disputes)
*
This is required to securely access and dispute items on your credit report in compliance with federal credit reporting regulations. Your information is encrypted and never shared.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Preferred language?
English
Spanish
Current Credit Score (Estimate)
*
Please Select
Below 500
500–579 (Poor)
580–669 (Fair)
670–739 (Good)
740–799 (Very Good)
800+ (Exceptional)
Not Sure
Current Credit Score (Estimate) - Please select the range that best applies. If unsure, select “Not Sure.”
*
Below 500
500–579
580–669
670–739
800+
Not Sure
Please give reference of any two people whom you feel would benefit from this:
Rows
Full Name
Email Address
Contact Number
1
2
Submit
Should be Empty: