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Do you have an attorney?
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Why Are You Considering Bankruptcy?
(check all that apply)
Garnishment
Loss of Income
Divorce
License Suspension
Illness/Disability
Lawsuits
Foreclosure
Repossession
Creditors
Other
Estimate Total Debt
: $
Which bills do you have?
(check all that apply)
Credit card
Personal loans
Child support
Student loans
Auto loans
Income taxes
Payday loans
Medical bills
Rent
Mortgage Payment
Other
Total Monthly Expenses
: $
Do you own real estate?
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Are you behind on the real estate payments?
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No
Do you own a vehicle?
Yes
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Behind on vehicle?
Yes
No
Do you have any additional assets worth more than $1,000?
Yes
No
Please Indicate the Sources and How Much?
Which types of income do you have?
(check all that apply)
Employed, Full-time
Child Support
Employed, Part-time
Social Security
Pension/Retirement
Maintenance
No Income
Other
Estimate Total Monthly Income
: $
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