Please Tell Us a Little About Yourself: Name*
First
Last
Do you have any dependents that live with you?* Include elderly family members.
Do you have anything you would like to tell me regarding your personal information that you have not already shared?
Please tell us about situations that might require our immediate attention. Please check all that apply.
Please tell us about this situation
Now let’s talk about your debts. Please list the type of debts (for example: rent, repossessions, business debt) and the approximate amount you owe. Do you have anything you would like to tell me regarding your debts that you have not already shared?
Now let’s talk about things you own: Please list the type of real estate, how much you owe on it (if anything), and its approximate value (best guess). If you own more than one property, please list each one.
Please list each one of your vehicles, how much you owe on it (if anything) and its approximate value.*
Please tell me a little bit about them, including the approximate opening date and closing date (in any).
Please list anything of value that you may have a right to receive (for example, assets from a deceased relative, personal injury lawsuit, or workers compensation settlement).*
Do you have anything you would like to tell me regarding items you own that you have not already shared?
Let’s Talk About Income: Do you or your spouse contribute to a 401K or other retirement plan? Are you or your spouse paying back a 401K or other retirement plan loan? Do you have anything you would like to tell me about your income that you have not already shared?
Now let's talk about some of your monthly household expenses. Estimates are fine. Please list any other monthly expenses not already listed, for example: storage fees, gym memberships, timeshare payments. If you have more than one extra expense, just press the + button at the end of the line.
Do you have anything you would like to tell me about your expenses that you have not already shared?
A Few Final Matters Are you concerned about your credit rating? If you have ever been sued, please check off the type of lawsuit it was. Pick as many as necessary. Do you have a right to sue anyone?* Have you ever filed for bankruptcy before (required)?* Have you transferred anything worth over $5,000 in the last 2 years (for example: cars, real estate, one time cash transfers)? Please list the items and the approximate amount, if anything, you received for each one. Are you an owner, beneficiary, or trustee of a trust? Finally, please tell me anything you feel would help me understand your situation.