First Name
*
Last Name
*
Phone
*
Email
*
What is your most important reason for wanting to repair your credit?
*
I want to buy a home
I want to buy a car
I want approval for a loan
I want cheaper interest rates
I want a credit card
Do you have any negative items on your credit report?
*
Yes
No
I'm not sure
Do you have any bankruptcies?
*
Yes
No
What's Your Approximate Monthly Income?
*
$1k - $3k per Month
$3k - $5k per Month
$5k - $10k per Month
$10k - $15k per Month
$15k+ per Month
When do you want to get started on fixing your credit?
*
I want to start: Right Away
I want to start: Next Week
I want to start: In 2 weeks
I want to start: Next Month
Are you in a financial position right now to invest in your Credit Repair?
Yes
No
I think so
Can we count on you to SHOW UP for your appointment?
*
YES, I will show up & respect the appointment time
No, I will not show up
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