FREE BANKRUPTCY EVALUATION FORM

Free Bankruptcy Evaluation Form

We appreciate you completing the enclosed form so that we may better evaluate your situation. Thank you.

Your Name (required)

Telephone Number (required)

Best Time to Return a Call (required)

Your Email (required)

1. Are you married?

2. No. of Dependent Children of Parents

Do you have any elderly parents that live in your household? If so, how many?

3. What is your approximate gross monthly income? If you are married, what is your spouse’s income?
Your Income:

Spouses Income:

4. If you are married, do you plan to file individually or with your spouse?

5. Do you own a home? Approximate fair market value?

6. What is the amount still owed on the home, between any 1st or 2nd mortgages or home equity loans?

7. Are you behind on the mortgage? If so, how many months behind? Are you facing a mortgage foreclosure or Sheriff’s sale?

8. Do you have any unsecured debt, such as credit cards or outstanding utility debt?

If yes how much?

9. Do you owe back taxes?

10. What is the approximate total of taxes owed?