credit-repair-intake

Personal Information

* Required fields

Full Legal Name

Date of Birth

Social Security Number (Last 4 digits)

We only request the last 4 digits.

Driver's License Number

Current Address

City

State

ZIP Code

Primary Phone

Email Address

Preferred Contact Method

Phone Email Text

Employment Information

Employment Status

Current Employer

Job Title/Position

Length of Employment

Your Credit Repair Goals

Primary Goal (select one)

Timeline for Achieving Goal

What would achieving better credit mean to you?

Additional Information

Have you worked with a credit repair company before?

Yes No

How did you hear about Fast Track Solutions and Services LLC?

Additional Comments or Information

Authorization & Disclosures

IMPORTANT DISCLOSURES - PLEASE READ CAREFULLY

Credit Repair Organizations Act (CROA) Notice: You have the right to dispute inaccurate information in your credit report yourself, at no cost, by contacting the credit bureaus directly. You may cancel this contract without penalty or obligation at any time before midnight of the 3rd business day after the date on which you signed this contract.

No Guarantees: Fast Track Solutions and Services LLC cannot guarantee specific results or a specific increase to your credit score. Credit repair outcomes vary based on individual circumstances. We will dispute inaccurate, unverifiable, or unfair items on your credit report. Results depend on credit bureau responses.

Service Timeline: Most credit repair services take between 3-6 months. Some cases take longer based on complexity and response times.

Your Rights: You have the right to receive a copy of your consumer credit file from each credit reporting agency. You may obtain a free copy of your credit report once every 12 months from each credit bureau at annualcreditreport.com.

Authorization to Act: By signing below, you authorize Fast Track Solutions and Services LLC to act on your behalf to dispute items on your credit report, communicate with credit bureaus and creditors, and take other lawful actions to improve your credit profile.

Privacy: We protect your personal information and handle all data in accordance with applicable privacy laws and our privacy policy.

I have read and understand the above disclosures. I authorize Fast Track Solutions and Services LLC to work on my behalf to repair my credit.

I understand that credit repair is not a guarantee and results may vary based on my individual circumstances.

I acknowledge my right to cancel this agreement within 3 business days without penalty.

I certify that all information provided in this intake form is true and accurate to the best of my knowledge.

Client Signature

Typing your name serves as your electronic signature.

Date

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Credit Repair Client Intake Form