Bankruptcy Form - Chivis Law Firm Texas Bankruptcy Attorney

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?
Spouses Name
Only if married filing jointly.
Number of Dependents
Number of dependents that reside in household.
Household Size
Number of total household size.
County of Residence*
Gross Monthly Income
Estimated gross monthly income, over the last 6 months.
Spouses Gross Monthly Income
Spouses estimated current monthly income,only if married.
Source of Income
What is your source(s) of income? (employer name, social security, pension, other)
Residence Status*
Do you own a home or rent your principal residence?
Home Payment Status
If own home, are payments late, and if so, how late?
Vehicle Status
Are you financing any vehicles, if so, how many?
Vehicle Payment Status
If 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 Debt
How much unsecured debt, debt without collateral, do you have?
Pending Litigation
Do you have any pending lawsuits or judgments against you?
Legal Plan
Are 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?
Phone
This field is for validation purposes and should be left unchanged.