Express Audit Form Part 1Between: Clear Credit Solutions (Provider) andClient *Address *PLEASE ANSWER ALL QUESTIONS AND TICK CORRECT RESPONSES Surname *Middle NameFirst Name *Have you used a credit repair agency before * Yes NoIf yes, name of InstitutionHow did you find us *Email *Have you ever used another name * Yes NoAny other surname you have usedAny other first name usedSex * Male FemaleDate of Birth *Do you currently hold a drivers licence * Yes NoCurrent drivers licence numberPrevious drivers licence numberDaytime Contact NumberHomeWorkMobile *Name of previous employerEmploymentAre you currently employed * Yes NoName of current employerSelf EmployedBusiness NameName of the company who you last applied for credit e.g. Name of bank or credit unionAddressCurrent residential address *Previous residential address*Additional previous addressAre you currently bankrupt or in a Part debt agreement * Yes NoCourt Judgements/Black MarksPlease list defaults/court judgements on your credit file: (If you are unaware of these listings an estimate is fine)AmountCompanyAmountCompanyAmountCompanyAmountCompanyPlease enter your full nameSigned by Client *Date *By signing you are agree to the terms and conditions, your on line signature is the same as your original signature and is binding to this contract.