Customer Intake Form

Credit Consultation Intake Form
Full Name

First NameLast Name
FULL SSN:
Example: 000-00-0000
Date Of Birth:
Example: 11/30/1999
Contact Number
Format: (000) 000-0000.
E-mail
example@example.com
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you have any OPEN/ACTIVE Credit Card Accounts? If so, please list limits and balances for each card here:
Do not include credit card accounts that are in collections, closed or charged off.
Credit Hero Score Login
This must stay active during the process
Email a copy of your state ID or passport and utility bill with your current address. The bill has to be less than two months old. Please send over to this email leusabrinam@gmail.com

Any questions please call/text 253-223-8149
WHAT'S INCLUDED?

3 Rounds of Disputes

(any negative accounts and hard inquiries added on after the 2nd round of disputes, will not be included. You do not want to apply for anything during the repair process)

Bi-Weekly Follow Up Calls

(This must be scheduled. My calendly link will be provided for you to book your 15 min one on one)

Mailing Services

(All letters are sent CERTIFIED to the credit bureaus and creditors)

Credit Building

(I will provide a list of Credit Builder Accounts that you can add to rebuild your credit once all negative items have been REMOVED and or updated)

RESULTS VARY FOR EACH CLIENT
Should be Empty:

Credit Consultation Intake Form