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Client Intake Form For Credit Restoration Services

Section 1: Personal Information

First Name *

Last Name *

Phone *

Email *

Date of birth *

Address

Street Address

City

State

Country

Postal code

Section 2: Credit and Financial Situation

Do you currently have any financial challenges, such as outstanding tax liens or past bankruptcies? *

Yes

No

If yes to any tax liens or bankruptcies, please provide a brief description, including relevant details.

Do you have plans to make a major purchase, like a house or a car, in the near future? *

YES

NO

If yes, what big purchase are you trying to make and when do you plan to make this purchase?

How quickly do you need your credit repaired? *

1-3 Months

3-6 Months

No specific time line, just want it done right

Have you worked with a credit repair company before? *

YES

NO

If yes, when was this and what was your experience?

Are you currently struggling with bills or other debts? If yes, briefly explain your situation. *

Section 3: Commitment and Expectations

Your Note

Are you currently struggling with bills or other debts? *

Yes

No

Are you comfortable with possibly waiting 6-9 months to complete this program? **(May be completed sooner )** *

Yes

No

Do you have the ability to make regular payments for credit-related costs if required(e.g., payments toward valid debts, monthly payment for this credit program)? *

Yes

No

Are you willing to provide the necessary documents (e.g., identification, credit reports, proof of income) to begin the credit repair process? *

Yes

No

Have you actively monitored your credit score in the past year? *

Yes, regularly

Yes, occasionally

No, not at all

Kway All Around Consulting require our clients to utilize Experian.com, MyEquifax.com and Transunion.com to access their reports. Please submit your login credentials for these 3 sites (create a FREE account if you don't have).

If you cant access the monitoring sites above you can upload your Experian, Equifax and Transunion Credit Reports from annualcreditreport.com in PDF Format Only

If cant access the monitoring sites above you can upload your Experian, Equifax and Transunion Credit Reports from annualcreditreport.com in PDF Format Only

How would you describe your financial goal for this credit repair service? *

Are you committed to following a budget and adjusting financial habits during this program? *

Yes

No

Not sure, would need guidance

Section 4: Financial Background & History

Do you have any outstanding collections or charge-offs on your credit report? *

Yes

No

If yes, please estimate the total amount of collections.

Are there any ongoing disputes regarding debts (e.g., medical bills, credit card charges)? *

Yes

No

If yes, please describe briefly.

Section 5: Employment and Income

Do you expect your income to change in the next 6-12 months? *

Increase

Decrease

Stay the same

Section 6: Payment Plan & Budget Considerations

Do you have a current monthly budget that you follow? *

Yes

No

Sometimes

Any additional information you think we should know about your financial situation?

Section 7: Understanding of the Process

Have you reviewed the typical steps involved in credit repair, including your responsibilities? *

Yes I understand the steps

No, I need furter information

Other

Do you understand that results may vary based on individual credit situations and are NOT GUARANTEED? *

Yes

No

Section 8: Consent and Additional Information

Do you consent to having Kway All Around Consulting contact you via email regarding the credit repair process? *

Yes

No

Are you willing to stay actively involved, respond to inquiries, and provide any necessary documents during the program? *

Yes

No

Do you agree to abide by all terms and conditions once your credit repair services begin? *

Yes

No

How did you hear about Kway All Around Consulting? *

Internet search

Social Media

Friend or family member

Privacy Disclaimer

We value your privacy and are committed to protecting your personal information. All the information you provide in this form will be kept strictly confidential and will only be used to evaluate your eligibility for our credit repair services. Your data will never be sold or shared with third parties without your explicit consent, except as required by law. We implement appropriate measures to ensure the security of your information, protecting it against unauthorized access, alteration, or misuse.

Date *

By signing below, you acknowledge that credit repair is a process and requires cooperation and patience. *

Clear

I confirm that all information provided is accurate. I understand that credit repair results vary and are not guaranteed. I consent to Kway All Around Consulting contacting me via phone, email, or text and agree to provide necessary documents and follow program guidelines.

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