• Credit Repair Client Intake & Consultation Form

    Complete this form to share your credit goals and situation—submission does not guarantee removal of accurate negative information or a specific score increase.

  • Client Information

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Preferred Contact Method

  • Credit Goals

  • Primary credit goals*

  • Credit Profile

  • Which credit bureaus do you currently monitor or receive reports from?*
  • Have you reviewed all three credit reports recently?*
  • Types of negative items present on your reports*
  • Do you believe any information on your reports is inaccurate or incomplete?*

  • Credit History & Background

  • Accounts Currently in Dispute
  • Prior Credit Repair Experience

  • Documentation & Readiness

  • Can you provide your current credit reports?*
  • Can you provide government-issued identification when needed for verification?*
  • Can you provide proof of address when needed for verification?*
  • Can you provide supporting documents for disputes?*

  • Identity / Theft Screening & Authorization

  • Do you suspect identity theft or unauthorized accounts?*
  • Authorization and acknowledgment*

  • Service Fit & Consultation

  • Preferred consultation date and time*

  • Final Acknowledgments & Signature

  • Acknowledgments*
  • Date Signed*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Certification Note
  • Should be Empty: