Giannis Financial Group Client Intake Form
Complete this intake form so we can assess your credit profile and build the best strategy for your goals.
Personal Information
Full Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Credit Goals / Credit Profile
What are you trying to accomplish? (Home, Car, Business Funding, etc.)
Current estimated credit score
Have you worked with a credit repair company before?
Please Select
Yes
No
Biggest credit challenge
Credit History Details
Do you currently have collections?
Please Select
Yes
No
Unsure
Do you have late payments?
Please Select
Yes
No
Unsure
Do you have charge-offs or repossessions?
Please Select
Yes
No
Unsure
Do you have active credit cards?
Please Select
Yes
No
Financial Information
Current employment status
Please Select
Employed
Self-Employed
Unemployed
Student
Retired
Other
Do you currently budget your expenses?
Please Select
Yes
No
Sometimes
Interested in wealth-building strategies?
Please Select
Yes
No
Maybe
Authorization & Acknowledgment
I confirm the information provided is accurate.
I confirm the information provided is accurate.
Signature
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: