Credit Repair Signup Form

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Please answer all questions so I can better understand how to meet your needs. Thank You!

First Name *

Last Name *

Phone Number

Why do you want your credit fixed? *

Want to buy a home.

Want to buy a car.

Need funding for a business.

Want to apply for a credit card.

I want to be prepared in case I need to apply for something.

All of the above

Other:

Are you financially stable to pay your bills for the next 6 months? *

Yes

Have you recently defaulted on any accounts, or had any 30 day late payments appear on your credit reports in the past 6 months? *

Yes

Are you in a position to pay down or pay off your debts? *

I can pay off all my debts

I can pay off some of my debts

I am unable to pay down any of my debts

I have no idea, my credit report stresses me out! I'm just too overwhelmed by all my debts!

Do you have any negative items linked to your current address? *

Yes

Have you worked on cleaning up your credit in the past 6 months? Or is a company currently working on cleaning up your credit? *

Yes

Are you in the middle of a bankruptcy process? *

Yes

Are you in an urgent need to move? *

Yes

Is there anything else you'd like to add that I may need to know? *

Who specifically referred you to me? *

Submit

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