| Bankruptcy Inquiry |
|
| *First Name: |
|
| *Last Name: |
|
| *Email: |
|
| Phone: |
|
| Mailing ZIP Code: |
|
| DO YOU HAVE CREDIT CARD DEBT? |
Yes
No |
|
*Credit Cards: Total Credit Card Debt:
*Combined Monthly Credit Card Payments:
|
| DO YOU HAVE OUTSTANDING MEDICAL BILLS? |
Yes
No |
|
*Medical Bills:
|
| DO YOU HAVE ANY PERSONAL LOANS? |
Yes
No |
|
*Total Personal Loan Debt:
*Combined Monthly Personal Loan Payments:
|
| DO YOU HAVE DEPT FROM AN AUTO ACCIDENT? |
Yes
No |
|
*Debt From Auto Accident:
|
| DO YOU OWN YOUR OWN HOME? |
Yes
No |
|
*Fair Market Home Value:
*Mortgage Payoff Amount:
*Combined Monthly Mortgage Payments:
*Are Your Mortgage Payments Current?:
Yes
No |
| DO YOU OWN INVESTMENT PROPERTY? |
Yes
No |
| DO YOU OWN A CAR? |
Yes
No |
|
Year:
*Car Payments:
Are your Payments Current?
Yes
No |
| DO YOU HAVE OUTSTANDING EDUCATIONAL DEBTS? |
Yes
No |
|
Educational Debts Payments:
|
| DO YOU OWE TAXES? |
Yes
No |
| DO YOU OWE CHILD SUPPORT PAYMENTS? |
Yes
No |
|
Child Support Payments:
|
| TAKE HOME INCOME? |
|
| AND HOW OFTEN? |
|
| DOSE YOUR HOUSEHOLD HAVE A SECOND INCOME? |
Yes
No |
What Is Your Take Home Income From This Second Income?
And How often?
|
| NUMBER OF PEOPLE IN THE HOUSEHOLD? |
Including Children:
|
| BEST TIME TO GET CALLED BACK? |
|
| |
|
|
|