Credit Repair Services
CLIENT REFERRAL INTAKE
Complete both sections referring client & new prospect information
1
Referring Client Information
Details about the existing client making this referral.
First Name
*
Last Name
*
Phone Number
*
2
Referred Prospect Information
Details about the new potential client being referred.
First Name
*
Last Name
*
Phone Number
*
Email Address
*
Best Time to Contact
Select time
Morning (8am–12pm)
Afternoon (12pm–5pm)
Evening (5pm–8pm)
Preferred Contact Method
Select method
Phone Call
Text Message
Email
3
Consent & Acknowledgment
Required before submitting the referral.
ⓘ
By submitting this form, the referring client confirms the prospect has agreed to be contacted regarding credit repair services.
The referred prospect is aware of and consents to being contacted. *
The referring client confirms the information above is accurate to the best of their knowledge.
The referring client understands any referral incentive is contingent on the prospect becoming a paying client.
Referring Client Signature (Type Full Name)
*
Date
*
Submit Referral