Free Bankruptcy Web Evaluation

Please complete in full, we will call back at the time you tell us is best for you and give you a free phone consult along with setting up an office appointment at that time.

You will still have to fill out a packet of bankruptcy forms in our office. You should plan for the entire consultation to last one to two hours.

After completing the evaluation, we will ask you to download our Creditor List and Budget Form to complete and bring into our office for the consultation.

Your Full Name: *

Your Spouse’s Full Name:

Street Address: *

City and Zip Code: *

Email Address: *

Best Phone # *

Second Phone #

Marital Status?

How many dependents do you have? *

When did you last file bankruptcy and under which
Chapter? (If you have never filed, put “NONE.”) *

How much is your current GROSS income
totaled over a year? *

How much is your spouse’s current GROSS
income totaled over a year? *

How much income from outside employment does
your household receive each month? *

What is your job title?
What is your spouse’s job title? *

Market Value of Real Estate / House:

Total balances of ALL mortgages:

Total monthly payments on
ALL mortgages: *

Do you have any lawsuits?

Vehicle #1 year, make, model, type:

Vehicle #1 market value:

Vehicle #1 car loan balance:

Vehicle #1 car note per month:

Vehicle #2 year, make, model, type:

Vehicle #2 market value:

Vehicle #2 car loan balance:

Vehicle #2 car note per month:

How much total debt do you have?
What type of debt? *

List all of your assets not provided elsewhere in this form
and values including real estate and personal property
valued over $3,000: *

Provide the best time and day for us to contact you: *

Where did you hear about us or find us?
If on the internet, please provide the website:*