1. What is your primary goal for improving your credit?

Copy And Print Document Below.

Econ Learning Center Credit Restoration Boost Mentorship Services Intake Form

New Clients Information

Your Name: ________________________________________________

Address:     ________________________________________________

City, State, Zip: _____________________________________________  

Phone Number: _____________________________________________

Email Address: _____________________________________________

New Clients Credit Goals

((Circle best answer relevant to you Below)

1. What is your primary goal for improving your credit? 

(A) Purchase a home,  (B) Car or Business  

(C) Get a Lower Interest Rate (D) Better Credit Status  (E) All Above

2.What is your desired credit score? (A) 600 (B) 650 (C) 720 (D) 850

3.What is your timeline for achieving your credit goals? 

(A) 6 Months to 2 YEARS (B) 3 to 4 YEARS   (C) 4 to 6 YEARS

Current Credit Situation ( Circle best Answer)

4.Do you currently have a copy of your 3 credit reports and 3 Credit Scores ? Yes Or No 

• If yes, please let us give you the opportunity to provide you with your very own Free Credit Repair Software Custom Portal for we can help you get a real transparent Affordable Smart Credit Reports/ Credit Score Resource for you. If You Have Them What is your current Fico Or Advantage 3 credit Reports credit score (if known)? Leave it Blank. 

                             ____________,  ______________ . ,_____________

5. Let Us Know if you have any negative items on your credit report, such as:

• Late payments

• Collections

• Charge-offs

• Foreclosures

• Bankruptcies

6. Do you know the reasons for these negative items? (Please explain)

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

New Clients Personal Financial Household Information

7. Current annual income:                                $__________________________

7A. Current Monthly Net Income: Not Gross  $__________________________

8. Total Monthly household Expenses            $__________________________

9. Total Monthly Credit Cards, Monthly Loans Or Debt Monthly payments: $______________

10. Total Discretionary Income After All monthly Debts and Expenses Payments Are Paid In Full:       $__________________________

Authorization

I, the undersigned, authorize Econ Learning Center to dispute inaccurate information on my credit report with the credit bureaus. I understand that I may dispute information on my own behalf and that the services provided by Econ Learning Center are not guaranteed to improve my credit score.

I have read and understand the terms and conditions of the credit repair services agreement.

Clients Name: _____________________________________________________

Clients Signature ____________________________________ Date:___________

Witness: Carlos Anaya 

Econ Learning Center Owner & Credit Restoration Financial Debt Freedom Independent Specialist/Educator. 

Signature: _____________________________________________ Date: __________