Bankruptcy Interview

 

The first step in eliminating your debt is to complete this free on-line interview. After analysis of your data, you will be contacted with some helpful advice and tips on how to resolve your specific credit situation. You can also download a copy of this form in Adobe Acrobat format to fill out and mail to our offices.
All information submitted will be kept strictly confidential and be used solely for purpose of this analysis. You can review our privacy policy for additional information on how we collect and use data.

General Information

Marital Status


Have you filed for bankruptcy before?


Name
 
 
 
 
 
 
Spouse's Full Name
 
 
 
 
 
 
Address
 
 
 
 
 
 
 
 
 

Husband's Employment (if applicable)

Are you employed?



 
 
 
 
 
 
 
 
 
How Often Are You Paid



 
 
 
 
 
 
 
 
 

Wife's Employment (if applicable)

Are you employed?



 
 
 
 
 
 
 
 
 
How Often Are You Paid



 
 
 
 
 
 
 
 
 

Property

 
 
 
Do you rent or own?


 
 
 

Mortgage (if applicable)

 
 
 
 
 
 
Are you current?


 
 
 
 
 
 

Vehicles

 
 
 
Do you owe money on this car?


 
 
 
 
 
 
 
 
 
Do you owe money on this car?


 
 
 
 
 
 

Additional Vehicles

Do you have an Additional Vehicles?


 
 
 

Bank Accounts

Do you have an Additional Vehicles?



 
 
 
 
 
 

Liabilities

Other than mortgages and lienholders on vehicles, do you have any other secured debt? (For example: furniture, jewelry, boats, RV's, business equipment, etc.) If so, describe collateral
 
 
 
 
 
 
 
 
 
Do you owe any taxes?


If Yes, do you owe income taxes?


If Yes, do you owe the IRS or state, or both?



 
 
 
Do you owe any student loans?


 
 
 
Do you owe any court fines (such as DUI's), back spousal support, welfare, or social security overpayment?


 
 
 

List All Remaining Unsecured Creditors

 
 
 
 
 
 

 
 
 
 
 
 

 
 
 
 
 
 

 
 
 
 
 
 

 
 
 
 
 
 

Additional Information

Additional Information Please provide any additional information not indicated above that you think is important, such as foreclosures, bank levies, wage garnishments, etc.