"PINK Palace Resolutions" Credit Repair Consultation/Intake Form
Welcome to PINK Palace Resolutions! Please complete the intake form below and answer all questions to the best of your knowledge to help begin your credit repair journey. Let's take your "FUTURE" to the top.
Personal Information
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Birth Date
*
-
Month
-
Day
Year
Date
Last 4 Digits of your SSN
*
We collect this information for identity purposes. Full SSN will be uploaded securely through our portal.
Credit Information
Are there any blemishes on your credit report?
Late Payments
Collections
Lien
Bankruptcy
Repossession
Judgement
Other
Are you having trouble qualifying for any of the following jobs?
Auto Loans
Jobs
Mortgages
Loans
Credit Cards
Apartment/Condo
Other
Credit Score
Ex: 800-850 as excellent
Have you ever had credit repair done before?
Yes
No
Other
Why do you need credit repair?
Additional Notes
Upload Driver License/Photo ID
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Copy Of Social Security Card
*
Browse Files
Drag and drop files here
Choose a file
Clear Copy Of Social Security Card Is Required For Identity Verification and Dispute Process
Cancel
of
Upload Proof Of Residence
Browse Files
Drag and drop files here
Choose a file
Acceptable Items: Lease, Utility Bill, Bank Statement, Phone Bill, ETC.
Cancel
of
I understand that credit repair is not an overnight process. Results can take anywhere from 30 to 90 days depending on the number & types of accounts require disputing. Also remember that 30 to 90 days doesn't mean when you submit your information. It means when I get to your submission and have completed my part is when the process begins.
*
I agree and understand
I authorize PINK Palace Resolutions to begin the process of preparing my credit file and to contact me regarding my report. I understand that I will receive an email with a secure upload link for my documents as well.
*
I agree and authorize services to begin
Please Read The Following
*
I acknowledge that I must maintain an active credit monitoring subscription which includes 3 Bureau Credit Monitoring in order for PINK Palace Resolutions to continue working on my credit file. You can choose a Credit Monitoring Subscription from one of the following: Smart Credit, MyFreeScoreNow, PrivacyGuard, Identity IQ, or Myscore IQ
*
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Credit Restoration
$99.00
$
99.00
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Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Signature
*
Please verify that you are human
*
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