LYFE Re-engineered for Individuals If you are human, leave this field blank. LYFE Re-engineered for Individuals Name * Email * Phone * Consultant Name or Rep ID# Who referred you? * Please select which product(s) you are interested in receiving a free assessment for: Credit Restoration (assessment available) Debt Reduction Software (assessment available) Discount Dental and Medical Program Student Loan Consolidation & Forgiveness Program (assessment available) Personal Funding (assessment available) Debt Reduction Assessment Remaining Loan Balance Mortgage Interest Rate Years to Pay Off Monthly Payment Estimated Property Value Monthly Income Monthly Expenses (excluding mortgage payment) Mortgage Type USA Canadian Add Additional Mortgage Remaining Loan Balance Mortgage Interest Rate Years to Pay Off Monthly Payment Estimated Property Value Mortgage Type USA Canadian Consumer Debt Analysis Balance Interest Rate Payment Dental, Health, and Wellness Savings Assessment Are you an employer looking to provide discounted medical benefits to your employees? No Yes If yes, How many employees would you like to cover? Question you would like to get answered? Personal Funding Eligibility Assessment We can help you gain access to credit cards and lines of credit using your personal credit. Our in house pre-qualification tool, allows us to determine which funding opportunities you can pre-qualify for without pulling your credit. Length of time at the address Mortgage/Rental Amount Rent or Own Rent Own Do you have verifiable income? No Yes Annual Income Do you know your credit scores No Yes If so, What's your Equifax score? Trans Union score? Experian score? Has Your Credit been Repaired? No Yes Do You or Any of your Family have Associated with the Military? No Yes Do You Own a Business? No Yes Do You have Any Credit Freezes or Blocks on your Credit? No Yes Do You have Verifiable Tax Returns? No Yes How much funding are you seeking? Would you like to receive additional information? No Yes Do you have credit monitoring established? No Yes If so, please indicate which one and include your login credentials. (Last four of your SSN needed for Credit Check Total) Check the box next to area of concern Purchasing a home Purchasing a auto Increase your scores Accessing personal funding Lower credit card rates OtherOther Student Loan Consolidation Assessment Are you currently enrolled in school? No Yes Do you have student loans? No Yes Are your student loans in default? No Yes Are your student loans currently deferred? No Yes How much do you currently pay monthly? The total amount owed on student loans? Would you like to receive additional information? No Yes Would you like to receive additional information? No Yes Question you would like to get answered? Best method and time to contact you Phone Email Text Yes No Best Time Submit
