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Credit Repair Intake Form
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Email
*
Your email
Who can we thank for referring you?
*
Your answer
Last Name
*
Your answer
First Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Phone Number
*
Your answer
Current Address
*
Your answer
What are you needing removed from you credit reports?
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Your answer
How would you rate your current credit?
*
Bad (300-629)
Fair (630-689)
Good (690-719)
Other:
What credit monitoring service are you currently using?
*
Credit Karma
Credit Wise with Capital One
Credit Journey with Chase Bank
Identity IQ
None
Other:
Any additional information you would like to provide?
Your answer
Once your form is received you will receive an email on how to complete your enrollment. Make sure you select Ashley Kay on the referral box on the sign up screen!
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