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Please Tell Us a Little About Yourself: Name*
First
Last
Are you married?* No Yes Divorced Separated
What is the name of your spouse?
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. Approximate total amount you owe on credit cards? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate total of all signature loans, lines of credit and payday loans? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate amount of back child support or alimony? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate amount you owe on secured loans not including real estate or vehicle payments. $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate amount you owe in medical debt? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate amount you owe in student loans? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate amount you owe in fees, fines or restitution? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate amount you owe in debt to family members or business associates? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate amount you owe in tax debt? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Approximate amount you owe in any other debts? $0 $1-$5,000 $5,000-$10,000 $11,000-$20,000 $21,000-$30,000 $31,000-$40,000 $41,000-$50,000 $51,000-$75,000 $76,000-$100,000 Greater than $100,000
Do you and any ex-spouse have any debt related connections? For example: joint debts, co-signed loans, property, debt division in the divorce decree, child support. If yes, please tell me a little about the debt.
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: Do you or your spouse own any real estate? No Yes
This includes your residence, rental properties, timeshares, burial plots.
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.
Have you or your spouse owned any part of any business in the last three years? No Yes
Please tell me a little bit about them, including the approximate opening date and closing date (in any).
Do you have anything you would like to tell me regarding things you own that you have not already shared?
Let’s Talk About Income: Most recent 2 pay stubs In order for me to be able to provide you with the most helpful consultation I can, it is extremely important that I have an accurate figure for your income. You can attach them here, to an email at marty@null hawaiidebtsolutions.com or to a text to 468.7000. A photograph is fine but please make sure I can see the entire pay stub. If the stubs are not available, that's not a problem - just let me know in the notes box at the end of this section. If you get a message that says your file size is too large to attach here, please send them by email or text.
Estimated monthly income from other sources. Please list your estimated monthly income from any other sources (for example child support, retirement, business income, SNAP/EBT). Please list the source with the estimated income directly after it. If you have more than one source, please press the + button at the end of the line.
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 If you have ever been sued, please check off the type of lawsuit it was. Pick as many as necessary. Have you transferred anything worth over $1,000 in the last 2 years (for example: cars, real estate, one time cash transfers)? If so, please describe below.
Do you have a right to sue anyone or does anyone have a right to sue you (for example: for personal injury)? If so, please explain the issue below.
Are you an owner, beneficiary, or trustee of a trust? If so, please tell me a bit about the trust.
Finally, please tell me anything you feel would help me understand your situation.
We are a debt relief agency. We help people file for bankruptcy.