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CREDIT SERVICES Intake Form

Personal Information

Credit Score and History

What is your main credit concern? (Check all that apply)
If Yes, Please estimate your total debt 
Ex: "Start business," "Fix credit to buy house," "Need emergency funding"
Employed / Self-Employed / Unemployed / Other
Government Assistance?
Documents List:
Make sure to locate all of these documents now so you can be ready when our representative contacts you!

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