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CREDIT SERVICES Intake Form
Personal Information
First name
Last name
Email
*
Phone number
Date of birth
Street address
City
State/Region
Postal code
Previous address (if less than 2 years at current)
Credit Score and History
What is your credit score?
Please Select
Below 500
500-580
580-650
650-700
700+
What is your main credit concern? (Check all that apply)
Low credit score
Negative items (late payments, collections, charge-offs, etc)
Identity theft or fraud accounts
High credit utilization (maxed-out cards)
Too many hard inquiries
No credit history (need to build credit)
Public records (bankruptcies, liens, judgments)
Difficulty getting approved for loans, credit cards, or housing
Other
Would you like assistance with dispute letters to challenge inaccuracies?
Please Select
Yes
No
Any additional information you'd like us to know?
Blanket Financial is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you:
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By clicking submit below, you consent to allow Blanket Financial to store and process the personal information submitted above to provide you the content requested.
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