Couples Credit Repair Inquiry Form

Credit Repair Inquiry

Thank you for inquiring about our credit repair services. My name is Korea Hall, CEO of Consult with Korea, and we are dedicated to assisting you to the best of our ability. This form will only take a few moments to complete. Afterward, please submit your payment to proceed with the process. Please note that delays in completing the form and payment may result in a refusal of service.The entire enrollment process takes no longer than 30 minutes.

Personal Information
Full Name*

First NameLast Name
Partner Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
Partner Birth Date*

MonthDayYear
Picture of a valid government issued ID*

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(Partner) Picture of a valid government issued ID*

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Victim of Identity Theft? Upload police report here.

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(Partner) Victim of Identity Theft? Upload police report here.

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Next Steps
Do you guys understand credit repair can take 24+ months?*

YesNo
Phone Number*
Please enter a valid phone number.
(Partner) Phone Number*
Please enter a valid phone number.
Email*
Please enter a valid email.
(Partner) Email*
Please enter a valid email.
We understand that we must submit my payment of ($597 or $697) immediately after we submit this form to continue with our enrollment process!*

Yes
We understand that the card we pay with will be the card saved on file for autopay in the amount of ($179 or $229) Depends on package selection. (Can change in the future if need be) 2 separate payments unfortunately isn’t an option for this package.*

Yes, we understand.
We understand that the date of enrollment will be the same date for my future month to month payments. (If you signed up on the 29th/30th/ or 31st your payment date will automatically be set for the 28th) This date may be altered if needed.*

Yes, we understand.
Any back story you guys feel is extremely important to disclose? (If no, leave blank) This would be a good place to let me know if we will handle all correspondence with one person. Both still being held accountable of course!
Please make sure it's related to credit.
We consent that all the above information belongs to us. We consent that the card will be stored for future autopay payments on behalf of both of our payment combined into one.*

Clear
(Partner) Signature*

Clear
Please take a moment to review the following.

We're committed to a long-term approach to credit repair. We fully understand that genuine credit restoration is not an overnight solution.

If it were, no one would fulfill their financial obligations, and we’d all be able to escape our responsibilities, enjoying free cars, homes, and money.

We are here to take full accountability and place our trust in the process.
Please verify that you are human*
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