Fresh Start Credit Credit Repair

Secure Intake Form

*No pictures or information will be left on the device your are using to submit this form.

1. Client Contact information *

Address

Street Address

City

State

Zip Code

Phone *

Date of birth

Email *

2. State ID or Driver's License

State ID or Driver's License

3. Full Social Security Number

4. Experian Login Credentials

Experian Username
Experian Password
Experian Security Question Answer
Experian Pin Number

MyScore IQ or FreeScoreNow Login Detials:

MyScore or FreeScore Username
MyScore or FreeScore Password
Last 4 Social Security #

6. Submitting Person

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.