New Clients

Questionnaire for New Debt Relief Clients

What to bring to your appointment.

Drivers License or State ID
Recent Credit Report (if available)
Bills/Collection letters
Vehicles / Car Loan Information
Real Estate and/or Mortgage Information
Proof of Insurance on your House
Tax Returns (2 years if available)
Recent Paystubs
Our Questionaire

Complete the Questionnaire to the best of your ability. This form will help prepare you for the initial consultation, and can help the attorney best determine the most appropriate form of debt relief. You may either complete the form online below or download it and bring it with you to your appointment.

Client Confidential Worksheet

Your Name*
First Last
Email Address*
Marital Status
Address
Street Address Address Line 2 City State ZIP Code
Are you filing jointly with your spouse or individually?
Spouse Name
Marital Status
Address
Street Address Address Line 2 City State ZIP Code
Prior Bankruptcy Filed? If Yes: Where
When
Judge’s Name
Status of Case
LIST OF CREDITORS
Please list creditors below. Any additional creditors, please list on back.
Creditor
Account Number
Balance
Creditor
Account Number
Balance
Creditor
Account Number
Balance
Creditor
Account Number
Balance
Creditor
Account Number
Balance
PROPERTY INFORMATION
Real Property: (i.e.: home or land)
1. Location of property: (Full Address) Value: $
2. Cash on hand: $
3. Checking Account: $
Bank
Acct.No.
4. Savings Account: $
Bank
Acct.No.
5. Security deposits
$
6, Home Furnishings: Make a separate itemized list of all home furnishings broken down by room. (I.e.: Bedroom 1:bed - $25, dresser - $50, TV - $10)
7. Furs or Jewelry
Value
8. Firearms, sports or other hobby equipment:
Value
9. Interest in insurance policies, annuities, IRA, ERISA, 401k etc.
Value
10. Stock interest in an incorporat e d or un in corporated business.
Value
11. Interest in partnerships or joint ventures
12. Alimony, maintenance, support payments you are entitled to
13. Any tax refund s you are expecting $
14. Auto, truck, trailer, other v e hicle : Year
Make
Model
Value
15. Auto, truck, trailer, other v e hicle : Year
Make
Model
Value
16. Boats, Motors, Accessories
Value
EMPLOYER INFORMATION
Your Employer
Name
Occupation
Address (Full)
How often paid: (Circle one ) Weekly Bi ‐ weekly Twice a month Monthly Gross pay:
(before deductions)
Spouse Employer
Name
Occupation
Address (Full)
Any other source of income not listed
$
(Child support, pension, unemployment compensation, disability etc.)
ESTIMATED MONTHLY LIVING EXPENSES
Rent or Mortgage payment $
Property Taxes $
(if not included in mortgage payment)
Property Insurance $
Electric $
Water / Sewer $
Phone $
Garbage $
Cable $
Food $
Car Payment 1 $
Car Payment 2 $
Car Insurance $
Health Insurance $
Life Insurance $
Medical Insurance $
Cell Phone $
Other $
Nature of Payment
We put in standard amounts the court allows for transportation, home maintenance, recreation and clothing. Please fill out to the best of your ability. Thank you.
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Testimonials

I would like to express how grateful I am to your for saving my home, one day before a foreclosure autction was to take place. The stress of filing bankruptcy was eased by your office. Thank you for having as much heart as intelligence.

Eileen and J

My husband and I were completely satisfied with Eric he was so helpful to us and explained every step we had to take. I would recommend his law firm to my friends and family also anyone who ask me who could help them.

Nancy Merrill

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New Clients

Questionnaire for New Debt Relief Clients

Client Confidential Worksheet

LIST OF CREDITORS

PROPERTY INFORMATION

EMPLOYER INFORMATION

Your Employer

Spouse Employer

ESTIMATED MONTHLY LIVING EXPENSES

Contact Us

Testimonials

Eileen and J

Nancy Merrill

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