Bankruptcy Survey

This pre-consultation survey collects a prospective client's financial situation -income, debts, assets, and legal history- to help assess bankruptcy eligibility.

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Name*

First Name

Last Name

Email*

Phone Number*

Want to file bankruptcy for yourself or along with your spouse for joint debts?*

On my own Jointly with my spouse

What is your approximate monthly gross income or household income if filing with your spouse?*

Have you lived in Florida for the last 2 years? (If not, explain):*

Yes No

What are your card debts and approximate amounts owed?*

What are your Student Loan debts and approximate amounts owed?*

What are your Car Loan debts and approximate amounts owed?*

What are your Healthcare debts and approximate amounts owed?*

Do you own real estate?*

Yes No

Do you have a mortgage?*

Yes No

Do you own a vehicle?*

Yes No

Do you have a bank loan?*

Yes No

Do you have any pending lawsuits or wage garnishments?*

Yes No

Have you ever filed bankruptcy?*

Yes No

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