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Name
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Phone Number (Put if you want me to contact you by phone)
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E-mail (Put if you want me to contact you by e-mail)
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City where you live
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Ever filed bankruptcy before?
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If so, what year?
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How many automobiles do you have with your name on the title?
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Of those automobiles, how many do you still owe money on?
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How much are your total monthly automobile payments, if any?
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Do you own a boat, motorcycle, or travel trailer?
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How much do you pay each month, if anything, for the above?
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Do you own any time-share condos?
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Do you own any stocks, bonds or other investments outside of a retirement account?
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Do you own the home you live in?
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How much is your monthly mortgage/rent payment?
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Do you own land other than the land you live on?
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Have you been employed within the last 2 months?
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Have you been self-employed or owned a business within the last 5 years?
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What is your current gross income from work (how many $ per wk/mo/yr)
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How much did you report as your gross income on last year's taxes (if you are/were married, combined with spouse's income)?
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How much do you pay, if anything, each month toward student loans?
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Are you currently married and living with a spouse?
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If married, what is your spouse's current gross income (how many $ per wk/mo/yr)?
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How many children under 18 reside in your home with you?
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How much do you pay each month, if anything, for child care expenses for children in or outside your home?
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How much do you pay each month, if anything, for alimony and/or child support for children living outside your home?
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How much do you and/or a spouse residing with you receive, if anything, for child support?
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Do you plan to file bankruptcy within the next month?
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If you retain me, do you wish to meet me in my office or retain me by mail?
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