E&C Intake Form

This form gathers what we need to open your file, pull your credit reports, and begin your customized restoration plan. When you submit, your answers go straight to your coach — nothing is posted anywhere else.

Est. time: 10–15 min Have ready: your credit monitoring login

Don't have credit monitoring yet?

Enroll with one of the services below so you can see your credit report — each link opens in a new tab. Once you're signed up, come back to this intake form tab, choose that same provider under Credit Monitoring Access, and fill in your new login.

Enroll with Smart Credit Enroll with MyFreeScoreNow

Personal Information

Legal name and contact details, as they appear on your ID.

First name

Last name

Phone number

Email address

Date of birth

II.

Current Address

Must match the address on your proof-of-address document.

Street address

City

State

ZIP code

III.

Credit Monitoring Access

Provider

Smart Credit

MyFreeScoreNow

Username

Password

Sensitive field. Only submit this form over a trusted, private connection (avoid public Wi-Fi), and never share your monitoring login by email or text separately from this form.

IV.

Authorization

Client signature

Date

Thanks — you're all set.

Your intake form has been submitted. Your coach will reach out shortly to confirm everything's in order. If you don't hear back within a couple of business days, feel free to follow up directly.

Client Intake Form

Don't have credit monitoring yet?

Personal Information

Current Address

Credit Monitoring Access

Authorization

Thanks — you're all set.