Intake form

Name *

Email address *

Phone number

What is your current credit score?

What negative items are affecting your credit?

Please select at least one option.

Late payments

Collections

Charge-offs

Bankruptcy

Foreclosure

Judgments

Repossessions

How long have these negative items been on your report?

Have you previously worked with a credit repair company?

What is your primary goal for credit repair?

Please select at least one option.

Increase credit score

Remove negative items

Obtain a loan

Improve credit utilization

Increase chances for approval

Preferred contact method

What is your zip code?

Additional questions or comments

Credit Ninja™