get started today!

Please fill out the information below so that we can begin the process of helping you increase your credit score, lower your interest rates and if you have ever experienced any type of financial difficulties there is a high probability that your credit files DO NOT reflect your current financial status. Any type of negative inaccurate, incorrect or unverifiable information on your credit files can be removed. By telling us what type of negative accounts are being reported on your credit reports and the approximate ages of these accounts, we can evaluation your current situation and tell you if we feel our services can be of benefit to you. So, please take a few minutes and answer as many of these question as you can, approximate dates will be fine.

Please answer the following questions to best of your knowledge, estimated dates are fine.

Fields with an asterisk (*) are required.

**Information entered and submitted to The Credit Repair Group will never be sold and is used only by us to get a better idea of your credit repair needs.**

First Name*:                

Last Name*:                


Confirm Email*:           

Daytime Phone*:          

Alt Phone (cell, office):  



Zip Code:                    

Do you and your spouse (if applicable) have recent copies of all three of your credit reports?

yes   no

1. Have you ever filed bankruptcy?:

yes   no

2. Do you have any Tax Liens?:

yes   no

3. Do you have any Judgements?

yes   no

4. Do you have Collections accounts (even medical)?

yes   no

5. Do you have Charge Off accounts?:

yes   no

6. Have you ever had any real estate go into Foreclosure?:

yes   no

7. Do you have any Late Payments?:

yes   no

Is there anything else you would like to tell us about your credit situation to allow us to better serve you?


How did you find CRG?

What is your reason for wanting a higher credit score:

Refinance a home
Buy a car
Get Insurance
Get a credit card
Just want to


The Credit Repair Group
Pompano Beach, FL. 33073

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