Bankruptcy in Under 60 Seconds (11 questions)

For the fastest, easiest results regarding your bankruptcy, please answer the following questions. Once this form is submitted, we will be contacting you very soon.

1. Why are you thinking about filing for bankruptcy? * Creditor Harassment Divorce Illness or Disability Foreclosure Garnishment Lawsuit License Suspension Loss of Income Other
Please select all that apply.
2. What is your approximate total debt? * $ . Dollars Cents
If you do not know the exact amount, don't worry. Please estimate the total amount of money you owe so we can have a general idea of your situation.
3. What kinds of bills do you have? * Automobile Loans Child Support Credit Cards/Store Cards Income Taxes Medical Bills Personal Loans Student Loans Other
Please select all that apply.
4. What is the total monthly cost of these bills? * $ . Dollars Cents
If you don't know the exact amount, please approximate.
5. Do you own Real Estate? * Yes No
6. If you do own Real Estate, are you behind on your payments? * Yes No
7. Do you own an automobile? * Yes No
8. If you do own an automobile, are you behind on your payments? * Yes No
9. Do you have any other assets worth more than $1,000 ? * Yes No
If you are not sure, check "No" for now. We will determine this more specifically when we call you.
10. What types of income do you have? * Full-Time employment Part-Time employment Child Support/Maintenance Pension/Retirement Social Security Other No Income
Please select all that apply.
11. What is your total monthly income? * $ . Dollars Cents
If you don't known exactly how much, please approximate.
Contact Information
Your Name * First Last
Phone Number we can reach you at * - (###) - ### ####
When is the best time to call you? *
Email
If you would like our office to send you a free Bankruptcy Information Packet, please provide us with your mailing address.
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

This information will only be used by our office to send you an information packet regarding your case.

Bankruptcy in Under 60 Seconds (11 questions)

Bankruptcy in Under 60 Seconds (11 questions)

Contact Information