CLIENT PROFILE NORTHWEST BUSINESS ADVISORS, LLC N.W.B.A Representative: Barbara
Warren (210) 590-2401
9138 SE ST. HELENS ST.
P.O. BOX 2020
CLACKAMAS, OR 97015
PHONE: (503) 654-8748 FAX: (503) 654-8744
________/_____/_______
(Contract Date)
PRIMARY CLIENT INFORMATION
_______ - _____ - ________
__________________ ___________________ _____ (Social Security #)
(Last Name) (First Name) (M. Initial)
_______ / _____ / ________
(Date of Birth)
Current Address
_______________________ __________________________ ______ ___________
(Street Address) (City/Town) (State) (Zip-Code)
Previous Address (if less than 2 yrs at current address)
_______________________ __________________________ ______ ___________
(Street Address) (City/Town) (State) (Zip-Code)
Home Work Cell
Phone _____/______/______ Phone _____/______/______ Phone _____/______/______
___________________________________ _________________________________
(Employer) (Occupation)
What type of derogatory credit information What are the FIRST TWO things you
is on your Credit Reports? would do if you had good credit?
___ Judgments ___ Bankruptcy ___ Tax Lien
___ Repossessions ___ Collections
1. ________________________________
___ Charge-Offs ___ Late-Pays ___ Credit Denial
___ Foreclosures ___ Inquiries ___ Other
2. ________________________________
Make copy of: ____ Driver’s License _____ SS Card or Energy Bill
CO-CLIENT PROFILE NORTHWEST BUSINESS ADVISORS, LLC N.W.B.A Representative: Barbara
Warren (210) 590-2401
9138 SE ST. HELENS ST.
P.O. BOX 2020
CLACKAMAS, OR 97015
PHONE: (503) 654-8748 FAX: (503) 654-8744
________/_____/_______
(Contract Date)
CO-CLIENT INFORMATION
_______ - _____ - ________
__________________ ___________________ _____ (Social Security #)
(Last Name) (First Name) (M. Initial)
_______ / _____ / ________
(Date of Birth)
Current Address
_______________________ __________________________ ______ ___________
(Street Address) (City/Town) (State) (Zip-Code)
Previous Address (if less than 2 yrs at current address)
_______________________ __________________________ ______ ___________
(Street Address) (City/Town) (State) (Zip-Code)
Home Work Cell
Phone _____/______/______ Phone _____/______/______ Phone _____/______/______
___________________________________ _________________________________
(Employer) (Occupation)
What type of derogatory credit information What are the FIRST TWO things you
is on your Credit Reports? would do if you had good credit?
___ Judgments ___ Bankruptcy ___ Tax Lien
___ Repossessions ___ Collections
1. ________________________________
___ Charge-Offs ___ Late-Pays ___ Credit Denial
___ Foreclosures ___ Inquiries ___ Other
2. ________________________________
Make copy of: ____ Driver’s License _____ SS Card or Energy Bill
Mail to address at top of page.