Fill out our bankruptcy evaluation form and an attorney will contact you regarding your specific situation.

 

1. Personal Information
First Name:
Last Name:
Email Address:
Street Address:
City:
State:	WA OR	Zip:
Phone:

 

2. Bills (check all that apply)
	Credit Cards		Personal Loans
	Home Mortgage		Judgments
	Tax Debts		Government Fines (i.e., parking tickets)
	Student Loans		Auto Loans
	Medical Bills
Credit Card balance:$
Home Mortgage balance:$
Student Loan balance:$
Tax Debt balance:$
Auto Loan balance:$

 

3.  Property
Approximate Value of Home:$
Monthly Mortgage Payment:$
Are you behind on your mortgage payments?	yes no
Vehicles you own or make payments on?	1 2 3 4 5
Monthly Car Payments:$
Are you behind on your car payments?	yes no

 

4. Income
Monthly Household Income (after taxes and deductions):$
Other Monthly Income:		Disability		Part-Time Job
(check all that apply)		Social Security		Child Support
		Pension		Unemployment
		Rental Property		Workers' Compensation
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