THE CARTERWAY CREDIT REPAIR QUESTIONNAIRE
Client Intake form
BASIC INFORMATION
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
SSN# (Last 4 Digits)
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
*
Yes, I agree to receive SMS notifications from TheCarterway LLC at (877) 833-3548 regarding appointments, reminders, and updates. Message & data rates may apply. Reply STOP to unsubscribe or HELP for help. Consent is not a condition of purchase.
No, I do not want to receive SMS notifications from TheCarterway LLC.
Email
example@example.com
Current Address (No. P.O Box)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Next
CREDIT STATUS CHECK
1. Have you pulled your full credit report in the last 30 days?
Yes
No
I don’t know
If yes, upload or share the file via TCW portal
Browse Files
Drag and drop files here
Choose a file
Cancel
of
2. Which credit bureaus are showing negative items?
Experian
Equifax
TransUnion
3. What is your current credit score? (Experian, Equifax, TransUnion)
4. Do you have a child support account showing on your credit?
Yes
No
I don’t know
If yes, is it open, closed, or in arrears?
5. Do you have any collections, charge-offs, repo, evictions, or bankruptcies listed? List by type and amount • Example: 2 collections (Comcast $212, Sprint $365)
6. Are there late payments on any open accounts?
Yes
No
I don’t know
If yes, how many and from when?
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IDENTITY VERIFICATION ISSUES
7. Do you have old addresses or multiple names showing on your reports
Yes
No
I don’t know
8. Do you see inaccurate employers or phone numbers listed?
Yes
No
I don’t know
9. Have you frozen the secondary reporting agencies yet? (LexisNexis, SageStream, CoreLogic, Innovis, etc.)
Yes
No
I don’t know
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FINANCIAL HABITS + GOALS
10. Are you currently using more than 30% of your credit cards?
Yes
No
I don’t know
11. Do you have any open loans or installment accounts?
Yes
No
If yes, list them.
12. Are you planning to apply for:
Personal Credit
Business Funding
Home/Auto
None
13. What is your #1 goal with credit repair? (You can check more than one)
Buy a home
Fund a business
Remove child support
Travel/Make passive income
Clean it up for peace of mind
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LEGAL STRENGTH
14. Have you ever filed a CFPB complaint before?
Yes
No
I don’t know
15. Are you open to using consumer laws and arbitration tactics?
Yes, go hard
Maybe, depends on the risk
No, keep it light
Optional Add-On Questions
(for VIP/Advanced Clients)
Do you currently have a trust or business entity set up?
Yes
No
Are you interested in mentorship or learning how to fix your credit yourself?
Yes
No
Do you want to get paid from your credit damage using lawsuits or arbitration
Yes
No
Submit
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