Client Intake — Kali Credit Co.

Section 1 of 4

About you

The minimum I need to start. We'll handle the sensitive stuff (full SSN, etc.) on the call after engagement.

How did you find Kali Credit Co.? * If “referral” or “somewhere else” — who or where? (name or detail)

First name *

Last name *

Best phone (text-friendly) * Email *

Date of birth *

Last 4 of SSN (helps match bureau files)

Current mailing address * Florida resident? *

Yes — Florida is my primary residence Moving to Florida within 30 days No — not in Florida

Section 2 of 4

Your file

What's pulling your score down. Honest answers; this isn't a credit application — no one's getting denied here.

What's on your credit report that you want gone? *

Type a list. Collections, late payments, charge-offs, authorized-user damage, anything you can remember. Don't need to be exact.

Have you pulled your reports recently? *

Yes — I have current reports from all 3 bureaus I have one or two, not all three I have old reports (more than 3 months) No — I haven't pulled them

Roughly where is your score today? (estimate is fine) Anything urgent on a timeline? (mortgage app, court date, etc.)

Section 3 of 4

What you're working toward

The score number that would actually change something for you — and what.

Target score (your best guess) What does that score unlock for you? * Which plan fits best? *

$499 flat — pay once, save $95 vs. plans $179/month × 3 — total $537, auto-ends at month 3 $99/month × 6 — total $594, auto-ends at month 6 Not sure yet — discuss on the call

Section 4 of 4

Authorization & consent

Federally required. Read carefully — you have rights.

By submitting this intake, you authorize Kali Credit Co. to:

Review the credit-file information you provide
Draft and send certified-mail demand letters on your behalf to creditors and collectors under FDCPA §809
File federal regulatory complaints on accounts you authorize the firm to escalate
Send written correspondence to the three credit bureaus on your behalf under FCRA disputes you specifically authorize

This is a limited authorization for credit-restoration correspondence only. It is not a general power of attorney. You may revoke it in writing at any time.

I authorize Kali Credit Co. to act on my behalf for credit-restoration correspondence as described above. * I have read the engagement terms and required disclosures at kalicreditco.com/terms, including the Consumer Credit File Rights notice and the 3-business-day right to cancel. * I understand no specific outcome is guaranteed — Kali Credit Co. provides educational consulting and written correspondence services. Score changes and deletions depend on factors outside the firm's control. * I understand Kali Credit Co. is a Florida-registered Credit Service Organization that operates nationwide under the federal Credit Repair Organizations Act and the applicable Credit Services Organization statute of my state of residence. * Type your full legal name to sign *

By typing my full legal name above and submitting this form, I am providing my electronic signature with the same legal effect as a handwritten signature, on today's date.

Kali will text you from (352) 586-3704 within 24 hours.

Let's get your file working.

Intake received. Kali's reading it now.