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:
Married
Single
Have you ever filed for Bankruptcy before?:
Yes
No
Your Full Name: *
Your Email Address: *
Spouse's Full Name:
Spouse's Email Address:
Address 1:
Address 2:
City:
State:
Zip Code:
Telephone Number:
Employment
Husband(if applicable): Are you employed?
Yes
No
Self Employed
What is your occuption?
What is your employer's name?
How long have you been employed?

How often are you paid?

Weekly

Bi-Weekly

Twice Monthly

What are your gross wages per pay period?
What is your take home (net) per pay period?
Husband: Do you have other sources of income? (unemployment, AFDC, spousal or child support, trust income, etc.)
Yes
No
Please identify other income sources:
Other income source amount:
Wife (if applicable): Are you employed?
Yes
No
Self Employed
What is your occuption?
What is your employer's name?
How long have you been employed?
How often are you paid?
Weekly
Bi-Weekly
Twice Monthly
What are your gross wages per pay period?
What is your take home (net) per pay period?
Wife: Do you have other sources of income?
Yes
No
Please identify other income sources:
Other income source amount:
Residence (and other real estate)
Residence (and other real estate):
Do you own or rent?
Own
Rent
If renting, how much monthly?
If you own, what is the value of your residence?
How much do you owe on the property (total)?
1st Mortgage (if applicable)
Name:
Amount:
Monthly Payment:
Are you current?:
Yes
No
If behind, how far?:
2nd Mortgage (if applicable)
Name:
Amount:
Monthly Payment:
Are you current?:
Yes
No
If behind, how far?:
Do you intend to stay?:
Yes
No
Do you own any other real estate?:
Yes
No
Describe other real estate:
Value of other real estate:
Vehicles
1st Vehicle (if applicable)
Year and make of car:
Value of car (low blue book):
Do you owe money on this car?:
Yes
No
If yes, to who?:
Total amount owed:
Monthly payment:
Number of payments left:
2nd Vehicle (if applicable)
Year and make of car:
Value of car (low blue book):
Do you owe money on this car?:
Yes
No
If yes, to who?:
Total amount owed:
Monthly payment:
Number of payments left:
Do you own or lease any other vehicles? (describe):
Bank Accounts and Other Assets
Do you have a checking or savings account?:
Yes
No
Name of Bank or Institution:
Approximate Balance:
Other deposit accounts:
Any other assets (not including ordinary household goods)?:
Liabilites
Other than mortgages and lienholders on vehicles, do you have a any other secured debt? (For example: furniture, jewelry, boats, RV's, business equipment, etc.)
Yes
No
If so, describe colleteral:
Value:
Name of creditor:
Total amount owed:
Monthly payment:
Number of payments remaining:
Do you owe any taxes?:
Yes
No
Total amount owed:
Do you owe any student loans?:
Yes
No
Total amount owed:
Do you owe any court fines (such as DUI's), back spousal support, welfare, or social security overpayment?:
Yes
No
List All Remaining Unsecured Creditors
Credit Cards:
Amount:
Medical Bills:
Amount:
Describe:
Personal Loans:
Amount:
Describe:
Other Unsecured Liabilities:
Amount:
Describe:
Judgements Civil:
Amount:
Describe:
Submit Interview For Review

*Required fields

Personal Bankruptcy

The main options available to consumers are Chapter 7 and Chapter 13. Each type of bankruptcy offers different advantages, depending upon your unique set of circumstances.
Read more

Small Business Bankruptcy

Like consumers, businesses have different bankruptcy options to consider as well.
Read more

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Law Offices of Craig Burnett is located in Santa Rosa, CA and serves clients in and around Santa Rosa, Fulton, Healdsburg, Graton, Sebastopol, Windsor, Forestville, Camp Meeker, Valley Ford, Guerneville, Vineburg, Monte Rio, Penngrove, Rio Nido, Bodega, Petaluma, Kenwood, Glen Ellen, Occidental, Villa Grande, Cloverdale, Bodega Bay, Marin County, Napa County, Sonoma County.

We are a federally-designated debt relief agency. We help people file for bankruptcy relief under the Bankruptcy Code.

537 4th Street | Suite A | Santa Rosa, CA 95401
Phone: (707) 523-3328 | Fax: (707) 523-3082

Attorney Advertising. This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.
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Law Offices of Craig A. Burnett

Interview

General Information

Employment

Residence (and other real estate)

1st Mortgage (if applicable)

2nd Mortgage (if applicable)

Vehicles

1st Vehicle (if applicable)

2nd Vehicle (if applicable)

Bank Accounts and Other Assets

Liabilites

List All Remaining Unsecured Creditors

Submit Interview For Review

Personal Bankruptcy

Small Business Bankruptcy