New Client Enrollment & Credit Repair Intake Form

New Client Enrollment & Credit Repair Intake Form

Complete this intake to enroll in D&S TAX AND FINANCIAL Solutions and securely submit required details and documents.
Client Agreement & Identity
Full Legal Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Communication Method
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Upload proof of your current address

Examples: utility bill, bank statement, lease, or government mail
Cancelof
Upload a clear copy/photo of your Social Security card

Cancelof
Upload Government-Issued ID

Cancelof
Credit Monitoring & Authorization
Are you currently enrolled in credit monitoring?
Credit monitoring must stay active and paid/current during the entire program
E-Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Acknowledgment
Should be Empty: