Credit Repair Intake
Welcome! Please complete this intake form in full. Once submitted, you'll be directed to set up your required credit monitoring based on your plan.
Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Last 4 of Social Security Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
YOUR OFFER
Promo Code/Offer you were quoted:
*
Enter the promo code or offer shared with you. If none, type N/A.
How did you hear about us?
*
Please Select
Facebook
Instagram
Referral
Other
DISPUTE PREFERENCES
Do you have Late Payments?
*
YES
NO
Do you authorize Truss United LLC to dispute you late payments?
*
YES
NO
List any accounts you do NOT want disputed.
*
Type N/A if none.
CREDIT MONITORING PLAN
Select your credit monitoring plan.
*
Please Select
Monthly Plan - $29.90/mo
Free Plan - $79.95/mo
DIY Community Plan - $39.95/mo
AGREEMENTS
Check ALL to agree and move forward:
*
I understand that credit repair results vary and are not guaranteed. I acknowledge that I am still responsible for any legitimate debts owed and that Truss United LLC cannot guarantee the removal of any specific item from my credit report.
I confirm that I am NOT a resident of the state of Georgia (GA). I understand that credit repair services are not available to Georgia residents and that providing false information may result in immediate termination of services without refund.
I understand that credit monitoring is mandatory for all Truss United LLC clients. I agree to complete my client portal onboarding within 48 hours of submitting this form. I understand that failure to do so may delay the start of my dispute process.
SIGNATURE AND SUBMIT
Signature
*
Date
-
Month
-
Day
Year
Date
Complete Enrollment
Complete Enrollment
Should be Empty: