Serenity Consulting Group Client Intake Form

Client Information

Please provide your personal and contact details.
Full Legal Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Social Security Number
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Have you lived at this address for at least 2 years?
If No, Previous Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Contact Method
Identity Verification Uploads

Please upload the following documents for compliance and verification purposes.
Upload Photo ID (Driver's License, State ID, or Passport)

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Upload Proof of Residency (Utility Bill, Lease, or Bank Statement)

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Credit Profile Overview

Help us understand your current credit situation.
Do you currently have active credit monitoring?
If Yes, Name of Monitoring Service
Upload Most Recent Credit Report

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Current Credit Score Range
Have you been denied credit in the last 12 months?
If yes, please explain
Have you filed bankruptcy?
If yes, please explain
How many open credit accounts do you currently have?
Select all that apply to your credit report:
If you selected “Other,” please briefly describe.
Credit Goals

Tell us about your main objectives for credit repair.
What is your primary goal?

Other
Target Credit Score Goal
Desired Timeline For Results
Please note: The timeline provided is for goal setting purposes only. Credit repair results and time-frames are not guaranteed and vary based on individual credit profiles, creditor responses, and reporting agencies.
Financial Snapshot

Provide information about your financial status.
Are you currently employed?
If yes, select employment type
Monthly Income Range
Estimated Total Monthly Debt Payments (USD)
Are you currently able to make more than the minimum payments on your debts?
Prior Credit Disputes

Tell us about any previous credit repair or disputes.
Have you previously disputed items on your credit report within the past 30 days?
Have you worked with another credit repair company within the past 30 days?
Have you contacted creditors directly regarding disputes within the past 30 days?
If yes, please provide the details.
Creditor and Bureau Details

Secure Access Instructions
For security purposes, please do not enter your credit bureau login credentials (username and password) anywhere on this Client Intake Form.

After submitting this form, please email your login credentials (username and password) for each of the following credit bureau accounts:

• Experian
• Equifax
• TransUnion

Email: kiara@serenityconsulting.co

Providing access to your credit bureau accounts allows us to review your credit reports, monitor changes, identify inaccurate, incomplete, or unverifiable information, and begin the credit repair process as efficiently as possible.

Thank you for your cooperation. We look forward to assisting you on your journey toward achieving your credit goals.
Secure Document Uploads

Upload any additional documents relevant to your credit repair case.
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Client Acknowledgment and Authorization

By checking each box and signing below, you acknowledge that you have read, understood, and agree to all statements outlined in this section.
By signing below, you acknowledge that you have read, understood, and agree to the disclosures and compliance statements listed above.
Date of Signature

MonthDayYear
Date
Should be Empty:

Client Information

Identity Verification Uploads

Credit Profile Overview

Credit Goals

Financial Snapshot

Prior Credit Disputes

Creditor and Bureau Details

Secure Document Uploads

Client Acknowledgment and Authorization