Client Intake Form

First Name*
Last Name*
Email*
Phone*
Date of Birth*
SSN*
Address*
Street Address City State ZIP Code
If you're a partner, please enter your information below. If not, you may skip these next two fields.
Partner Name
Partner Email

Please fill out all the inquiries per bureau you would like removed and add the date of the inquiry at the end.
Example: Creditor Name 02/15/2018
*Make sure not to dispute any inquiries on your credit report that are attached to a live account - i.e. an inquiry that resulted in an account you legitimately opened or this could result in them closing your account*
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Experian
Equifax
TransUnion
Click on the + sign to add more inquiries.
Experian Equifax TransUnion

Form of Identification*
Accepted file types: jpg, png, doc, pdf, jpeg.
Drivers License/Passport/Government ID
Proof of Address*
Accepted file types: jpg, png, doc, pdf, jpeg.
SS Card*
Accepted file types: jpg, png, doc, pdf, jpeg.

Client Intake Form – Gold

Experian	Equifax	TransUnion