Bankruptcy Evaluation Form

Bankruptcy Evaluation Form

Welcome to our Online Bankruptcy Evaluation Form. We have provided this online form to help collect data to determine if bankruptcy is right for you and your family.

These key questions assist the attorneys in determining a strategy to control and maybe eliminate your debt. Fill out this form today to obtain complementary information about your financial portfolio. By filling out this form you are not creating an attorney/client relationship. This is for informational purposes only and the dual execution of a retainer agreement would need to be done to create an attorney/client relationship.

Asterisk (*) indicates a required field of information – Complete this form and submit for a complimentary 15-minute phone consultation.

Home Address:
Marital Status:
Spouse Full Name: (if applicable)
More Details: -----------------------
Employment Status:
Spouse Employment Status: (if applicable)
Have you ever filed bankruptcy before?
If Yes, what was the date of your discharge?
Do you own any real estate property (homes, buildings, land, etc.,)?
If yes, Check all that apply:
Are any of your properties in foreclosure:
List any vehicles, boats, travel trailers, etc., that you/your spouse own and are titled in your name (spouse name):
List monthly payments for each vehicle:
What is your monthly gross income for the entire household (including alimony you may receive)?
Do you/your spouse receive any other source of income (Social Security, Disability, Unemployment, etc.,)?
If Yes, list the source of income and monthly amount(s)?
How many people live in your home?
Are you being sued by anyone?
In the last 2 years, have you paid off any debt to family, friends or any company that you own?
If Yes, when and how much?
Have you transferred any property from your name to someone else in the last 2 years?
Please list approximate amounts of any of the following debts you have: