Free Credit Solutions - Credit Assessment Form

Credit Assessment Form

Please complete the form below. This information is needed to assess your situation.
Remember that you do not need to provide an account number.

Name :
Email :
What is your credit score?
What do you plan to purchase within the next 6-12 months:
Are you starting a business?
What is your goal in reference to your credit/finances?
What state do you reside:
Credit Accounts
Name of Creditor :
What was your date of last activity on this account? This is the last date that you used the card/account or the last payment made:
Type of credit:
Is there Collateral related to this credit account, for example an automobile. :
Payment Due Date:
Monthly payment: :
Are your payments current?
How many times were you....
30 days late
60 days late
90 days late
120 days late
Is this account charged off rated “R-9”?
Is there a repossession associated with this account?
Credit Account 2
Name of Creditor :
What was your date of last activity on this account? This is the last date that you used the card/account or the last payment made:
Type of credit:
Is there Collateral related to this credit account, for example an automobile. :
Payment Due Date:
Monthly payment: :
Are your payments current?
How many times were you....
30 days late
60 days late
90 days late
120 days late
Is this account charged off rated “R-9”?
Is there a repossession associated with this account?
Credit Account 3
Name of Creditor :
What was your date of last activity on this account? This is the last date that you used the card/account or the last payment made:
Type of credit:
Is there Collateral related to this credit account, for example an automobile. :
Payment Due Date:
Monthly payment: :
Are your payments current?
How many times were you....
30 days late
60 days late
90 days late
120 days late
Is this account charged off rated “R-9”?
Is there a repossession associated with this account?
Credit Account 4
Name of Creditor :
What was your date of last activity on this account? This is the last date that you used the card/account or the last payment made:
Type of credit:
Is there Collateral related to this credit account, for example an automobile. :
Payment Due Date:
Monthly payment: :
Are your payments current?
How many times were you....
30 days late
60 days late
90 days late
120 days late
Is this account charged off rated “R-9”?
Is there a repossession associated with this account?
Credit Account 5
Name of Creditor :
What was your date of last activity on this account? This is the last date that you used the card/account or the last payment made:
Type of credit:
Is there Collateral related to this credit account, for example an automobile. :
Payment Due Date:
Monthly payment: :
Are your payments current?
How many times were you....
30 days late
60 days late
90 days late
120 days late
Is this account charged off rated “R-9”?
Is there a repossession associated with this account?