CLIENT INFORMATION

First Name

Last Name

Date of birth

Social

Address

Street Address

City

State

Country

Postal code

Phone *

Email *

FINANCIAL INFORMATION

Employment Status

Monthly Income

Monthly Expenses (Rent/Mortgage, Utilities, Groceries, etc.):

Total Outstanding Debt ( Including Loans, Credit Cards, etc.):

CREDIT HISTORY

Have you reviewed your credit reports recently?

YES

Have you identified any inaccuracies or discrepancies on your credit reports?

YES

Please provide details about the inaccuracies or discrepancies you have identified:

Have you filed for bankruptcy in the past 7 years?

YES

Have you been a victim of identity theft?

YES

OTHER INFORMATION

Are there specific goals you would like to achieve through credit repair? (e.g., improve credit score, qualify for a mortgage, etc.)

Do you have any specific questions or concerns regarding the credit repair process?