To obtain a free preliminary case evaluation, please complete the form below and click "Submit." 
           
Personal Information 
    
Name:  

Address:  

City:   

State:  

Zip: 

Phone:  

Fax:  

E-mail:  
  
Best time to contact you:   
    
INCOME 
  
PERSONAL

Are you currently employed? 


How often do you get paid? 


What is your monthly net income?   
   

Is your spouse currently employed? 
 
How often does your spouse get paid? 
  
What is your spouse's monthly net income?
    
   

 
Do you have any other sources of income?

Briefly describe your other source of income

  
YOUR BILLS 
    
What types of bills do you currently have? 
 

PROPERTY (Real Estate) 

Do you own or rent a home?

If so, how much is it worth?


Do you have a loan or a mortgage on your home?

If so, how much is the aggregate outstanding balance?

What is your monthly mortgage obligation?  
    
Are you current on your home mortgage?   
    
Do you have any other property or real estate?   

Do you have an ownership interest in any business? 
 
Vehicles 
    
Do you own a vehicle?    

What kind of a vehicle ?                               
       

How much is it worth ?   

Do you owe any money on your vehicle?   

If so, how much?

What is your monthly payment? 

Are you current on your payments?   


Do you have any other vehicles?                       

Do you have any other assets worth more than $1000.00? 
 
Why are you considering bankruptcy? 

Did you file your Tax Return for (2009)  

Are you suing anybody 

In the last two years did you obtain any loan

In the last two years, have you transfer any
property from your name to somebody else's?


What chapter are you considering 
















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