Apply Now Express Audit Form Part 1 Between: Clear Credit Solutions (Provider) and Client * Address * PLEASE ANSWER ALL QUESTIONS AND TICK CORRECT RESPONSES Surname * Middle Name First Name * Have you used a credit repair agency before * Yes No If yes, name of Institution How did you find us * Email * Have you ever used another name * Yes No Any other surname you have used Any other first name used Sex * Male Female Date of Birth * Do you currently hold a drivers licence * Yes No Current drivers licence number Previous drivers licence number Daytime Contact Number Home Work Mobile * Name of previous employer Employment Are you currently employed * Yes No Name of current employer Self Employed Business Name Name of the company who you last applied for credit e.g. Name of bank or credit union Address Current residential address * Previous residential address* Additional previous address Are you currently bankrupt or in a Part debt agreement * Yes No Court Judgements/Black Marks Please list defaults/court judgements on your credit file: (If you are unaware of these listings an estimate is fine) Amount Company Amount Company Amount Company Amount Company Please enter your full name Signed 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.