IES Intake

Please know that once your information is submitted, Your information will be processed in the order it was received. One of our agents will contact you to verify your identity. Furthermore you will receive a contract via E-mail which allows us to work with your information on your behalf. if you have questions after reading it please ask the agent whom contacts you or reach out to us directly at 800-210-9812 press option 0 to be connected to a customer service agent. You may also E-mail us at info@creditzap.org

I.E.S. Intake

Please take your time and fill out every detail required. Please double check all of your spelling and all the information you provided on this form, as it will be used to verify your ID when we contact you.

* Indicates required field

Client FIRST NAME *

Client MIDDLE NAME *

Client LAST NAME *

Client Email *

Client PHONE *

Client SOCIAL SECURITY NUMBER *

Client D/O/B *

Client STREET ADDRESS (NO PO BOXES) *

Client CITY *

Client STATE *

Client ZIP *

Current Employer *

How many time shares are being cancelled *

Name of Timeshare(s) *

Timeshare Acct Number / Contract #'s *

I.E.S. Case Manager name *

How Many Clients are listed on the Time Share(s) *

***If there is more than one individual on said Timeshare(s) Please fill out below. If there is more than two individuals please place the third one in the Notes section below and include their Name, Number, E-mail address and Address. If you are missing any information please state that in the notes section as well and our team will aid and assist in obtaining said information.***

Additional First Name *

ADDITIONAL MIDDLE NAME *

Additional Last Name *

S-S-N *

D/O/B *

E-mail Address *

Phone Number *

Street Address *

City, State and Zip *

Is the Additional Individual the spouse of the first named. *

Notes *

Please note as stated above someone will be in contact with you in an effort to obtain or verify your SSN, DOB and a copy of your Identification within 24-48 hours. Upon Clicking Submit you will be taken to the upload center where you will be asked to upload a picture of your drivers license. This is used to verify your Identity.

Submit

All information is kept on a secure server and is never shared without written or recorded verbal consent.

I.E.S. Client Intake

I.E.S. Intake

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