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CRS CDR NEW CLIENT INTAKE FORM

PERSONAL INFORMATION

First name(Required)

Last name(Required)

Social Security #(Required)

Birthday(Required)

Month

Day

Year

Email(Required)

Phone(Required)

Are you a US Citizen? (Required)

Address on Your License

Do You Own or Rent?(Required)

How long have you lived at this addres?(Required)

How much do you pay on housing per month?(Required)

Current Credit Score

FINANCIAL INFORMATION

List the Bank Names & the Types of Accounts you currently have open (Checking/ Savings). If you do not have any answer: N/A(Required)

List the Personal Credit Cards you currently have (Name, Limit, History) If you do not have any answer: N/A(Required)

Do you have an Repos, Bankruptcy's or Student Loans on your report?(Required)

EMPLOYMENT INFORMATION

Name of Employer(Required)

Employers Address(Required)

How Many Years have you been Employed with the Company(Required)

How are you paid: Hourly? Salary? Freelance?(Required)

Annual Income (Before Taxes) (Required)

Are you able to supply check stubs or bank statements, if requested by the underwriter?(Required)

Do you receive direct deposit? (Required)

What is your Employment Status(Required)

Full Time

Part Time

Self Employed

Unemployed

Other

What is the highest level of education you have completed?(Required)

< High School

High School Diploma or Equivalent

Trade/Technical/Vocational

Associate Degree

Bachelor's Degree

Master's Degree

Professional Degree

Doctorate Degree

Prefer not to say

Other

BUSINESS INFORMATION

(Fill out only if this applies to you)

Do you own a business?

Yes

No

If Yes, What is the Name of Your Business

What is the Name of Your Business

What Year was your Business Registered?

Do you have business credit?

EXPERIAN LOGIN

Experian Username(Required)

Experian Password(Required)

Experian Security Question with Answer (If you have one)

Experian 4-Digit Pin (If you have a pin#)

TRANSUNION LOGIN

Transunion Username

Transunion Password

EQUIFAX LOGIN

Equifax Username

Equifax Password

NAV LOGIN

Nav Username

Nav Password

D&B Login

D&B Username

D&B Password

EXPERIAN'S INTELLISCORE LOGIN

Experian IntelliScore Username

Experian IntelliScore Password

EQUIFAX BUSINESS LOGIN

Equifax Business Username

Equifax Business Password

UPLOAD REQUESTED FILES

Upload a CLEAR COPY of the following requested documents.

They must all be READABLE.

Upload a Copy of Your License or Government Issued ID

Upload Copy of Your Social Security Card

Upload Proof of Address (Utility Bill or Front Page of Bank Statement) Must Match Your License.

Upload your most current pay stub (You may need to supply your three most recent paystubs, if requested by the underwriter).

AUTHORIZATION & ACKNOWLEDGMENT

I acknowledge that this information is accurate to the best of my knowledge.

I authorize CRS to access my Consumer Discloser Report. I have voluntarily provided my login credentials to all three credit bureaus. (Experian, Transunion, Equifax)

I acknowledge that by clicking "Submit" I am in agreement to all of the above.

185 State Route 36, Building A, Suite 210, West Long Branch, NJ 07764 | info@consumerreportsolutions.com

Submit your login info to www.consumerreportsolutions.com/discovery and schedule your discovery call.

By submitting your information to www.consumerreportsolutions.com you consent to share your login information and access to the personal and confidential information reporting on your consumer disclosure report via www.experian.com

PRIVATE POLICY | COOKIES

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