Bankruptcy Information BANKRUPTCY CLIENT CONSULTATION SHEET Name* First Middle Last Phone*Email* Enter Email Confirm Email Martial Status*Filing Status*Filing as individual or jointly, if married?IndividualJointlySpouses NameOnly if married filing jointly.Number of DependentsNumber of dependents that reside in household.012345678910+Household SizeNumber of total household size.12345678910+County of Residence*Gross Monthly IncomeEstimated gross monthly income, over the last 6 months.Spouses Gross Monthly IncomeSpouses estimated current monthly income,only if married.Source of IncomeWhat is your source(s) of income? (employer name, social security, pension, other)Residence Status*Do you own a home or rent your principal residence?RentOwnNone / ShelterHome Payment StatusIf own home, are payments late, and if so, how late?Ownership Interest*Do you have an ownership interest in any residences, properties or land that are not your primary residence or part of your primary residence?YesNoOwnership Interest DetailsWhere are these held and what do you think the approximate value is?Estates & Trusts* Are you the beneficiary of any estate or trust?YesNoEstates & Trusts DetailsWhat is the approximate value of your interest in the estate or trust?Deposits*Do you have more than $3000 held in total deposits in your checking/savings accounts? YesNoDeposit DetailsApproximately what is the total amount combined among all checking/savings accounts?Vehicle StatusAre you financing any vehicles, if so, how many?012345+Vehicle Payment StatusIf financing vehicles, are payments late, if so, how late?Previous Bankruptcy?Have you filed bankruptcy in the past? And if so, when? Date Format: MM slash DD slash YYYY Back Taxes?Do you the IRS any back taxes, if so, approximately how much?Unsecured DebtHow much unsecured debt, debt without collateral, do you have?0-10K10K-20K20K-30K30K-40K40K-50K50K+Pending LitigationDo you have any pending lawsuits or judgments against you?Legal PlanAre you a member of any legal plan? If Met Life, what is your case number and the last 4 digits of your social security number? If Texas Legal, what is your subscriber ID? How did you hear about us?NameThis field is for validation purposes and should be left unchanged. Δ