Credit Consulting Client Intake Form
Please fill out this form to help us understand your credit situation and goals.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Current Credit Score Range
*
Below 500
500-579
580-619
620-659
660-699
700+
What negatives are on your credit report?
*
Late Payments
Collections
Charge-offs
Bankruptcies
Repossession
Medical Debt
Identity Theft
Not Sure
How long have you been dealing with credit issues?
*
Less than 1 year
1-3 years
3-5 years
5+ years
What is your main goal?
*
Buy a home
Buy a car
Get approved for business credit
Lower interest rates
Just want to improve my score
How soon are you looking to fix your credit?
*
ASAP
Within 3 months
Just exploring
Submit
Should be Empty: