Credit Repair Intake Form

Do you currently have credit monitoring set up (Experian, IdentityIQ, SmartCredit, etc)? Required

Yes

No

Have you worked with a credit repair company or disputed items on your own before? Required

Yes

No

What is your main reason for wanting to fix your credit? (check all that apply) Required

Which types of negative items do you believe are on your credit reports? (check all that apply) Required

Are you currently able to keep up with your monthly bills?

Yes

No

Preferred payment method: Required

Debit card

Credit card

Bank draft

Are you ready to move forward with Jericho Financial for credit repair service? Required

Yes

No

Do you understand that Jericho Financial charges a monthly service fee for credit repair? Required

Yes

No