Initial Bankruptcy Evaluation

We can perform a quick review of your financial situation and come up with a pretty good idea of your options in bankruptcy. To get your initial evaluation, please complete this online questionnaire. If you would prefer to complete a physical copy instead, please print the questionnaire, then scan the completed version and send it back to my email address.

Identity

Name:

Spouse Name:

Street Address:

City:

State:

Zip Code:

Phone Number:

Email Address:

Have you filed for Bankruptcy before:

Do you have any children under the age of 18:

Do you have any children in college:

Income

Please provide a recent paycheck stub for each debtor if you can, or give me an estimate for all categories that apply.

Your Income:

Hourly Pay Rate:

Salary:

Average gross income per month:

Income from last year's tax returns:

Recent Paycheck Stub:

Accepted Formats: Excel Documents, Images, PDFs, Word Documents

Spouse Income:

Spouse Hourly Pay Rate:

Spouse Salary:

Spouse Average gross income per month:

Spouse income from last year's tax returns:

Spouse Recent Paycheck Stub:

Accepted Formats: Excel Documents, Images, PDFs, Word Documents

Assets

Do you own a home?:

Do you own other real estate?:

Do you own a vehicle?:

Business Assets

Are you self employed or the owner of a corporation or LLC?:

Creditors

Please list your creditors and amounts owing. I don't need addresses or exact amount, an estimate is fine and I don't need a complete list.

Creditor #1:

Amount #1:

Creditor #2:

Amount #2:

Creditor #3:

Amount #3:

Creditor #4:

Amount #4:

Creditor #5:

Amount #5:

Creditor #6:

Amount #6:

Do you have any student loans?: