Request a Bankruptcy Consultation Bankruptcy/ Debt Settlement Name* Email* Phone*Have you ever filed bankruptcy before?*YesNoAre you subject to any lawsuits or actions from collection companies?*YesNoIs your paycheck being garnished?*YesNoDo you have medical debt? If so, how much?*Do you owe debt from operating a business?*YesNoDo you own a home or any other real estate?*Do you have a mortgage on the real estate you own?*Are you employed? If you are considering filing jointly is your spouse currently employed?*What is your approximate household income?*When did you last file an income tax return? Do you owe any back taxes?*Have you ever experienced a vehicle repossession?*Does your debt include traffic tickets or DUI fines?*Do you own any vehicles? Please provide make, model, and mileage if possible.*Do you have a loan on any of your vehicles? What is the balance?*Are you married?*Do you have children? If so, how many and what are their ages?*Do you currently owe any child support?*YesNoHow much total credit card debt do you currently owe?*Do you have student loans?*How did you find out about our firm?**The use of this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.CommentsThis field is for validation purposes and should be left unchanged.