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?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?EmailThis field is for validation purposes and should be left unchanged.
