Credit Restoration Intake Form
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Birth Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number
*
Clear Copy of Social Security Card
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Driver's License (Military ID, Passport, State ID)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Current Utility Bill Within 30 Days
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Credit Report Information
Free Credit Reports
Please sign up, if not already for the following Credit Monitoring services. Do not have one? Not a problem, each link is listed below. Copy & Paste the link into a separate browsing tab.
Credit Score
Ex: 800-850 as excellent
Experian Free Credit Report (Copy & Paste this link to access)
https://www.experian.com/consumer-products/free-credit-report.html
Experian Login Information
*
Credit Karma Free Credit Report (Copy & Paste this link to access)
www.creditkarma.com
Credit Karma Login Information
*
My Equifax Free Credit Report (Copy & Paste this link to access)
www.myEquifax.com
MyEquifax Login Information
*
Chex System Consumer Disclosure Report (Copy & Paste this link to access)
https://www.chexsystems.com/request-reports/consumer-disclosure
Chex System Login Information
*
Disputed Accounts
Have you disputed any accounts ?
Negative Items
Are there any blemishes on your credit report?
Late Payments
Collections
Lien
Bankruptcy
Repossession
Judgement
Other
Notes
Identify Theft Information (if applicable)
Was your identity stolen?
Yes
No
Date of Theft
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Police Report Number
Details
Background need for restoration
Have you ever had credit repair done before?
Yes
No
Are you having trouble qualifying for any of the following jobs?
Auto Loans
Jobs
Mortgages
Loans
Credit Cards
Apartment/Condo
Other
Why do you need credit repair?
CRO (Referred By)
Authorization
I, the undersigned, authorize TRU ASSOCIATES LLC to access my credit reports from all three credits bureaus and dispute inaccurate or outdated information on my behalf in accordance with federal and state laws. I understand that results are not guaranteed and agree to provide all necessary documents to support my disputes.
Signature
Submit
Should be Empty: