Bankruptcy Questionnaire

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Find out if you qualify

Email *

Full Name *

Cell Phone *

State and county of residence

I live:

alone

with my spouse

with my children

with a roommate

some other arrangement

The following issues are affecting my life:

I have a wage or bank account garnishment

I have a foreclosure

I have an eviction

I am being sued

Creditors are harrassing me

I cannot make the minimum monthly payments on my debt

I have a repossession

I have an overwhelming amount of medical debt

I will never be able to catch up with my debt as it is now

I have a house or car that I can no longer afford to keep

I have recently lost my job or my income has changed

I have a judgment or physicians lien on my home

I owe money for:

secured creditors (usually houses and cars)

the IRS or other tax liability

student loans

credit cards, personal loans, and/or payday loans

child support

other things

I estimate my total debt to be:

less than $20,000

between $20,000 and $100,000

more than $100,000

Clear selection

I own the following items:

A house or land

A car

A boat, rv, or trailer

Oil or mineral rights

My income is from:

my job

social security and/or disability

my own business

some other source

I estimate my monthly household income to be:

between $0 and $1,000 a month

between $1,000 and $3,000 a month

between $3,000 and $5,000 a month

between $5,000 and $8,000 a month

over $8,000 a month

Clear selection

I have access to the following;

a computer or laptop

a smartphone

a printer

a scanner

I prefer to be contacted:

by email

by phone

Clear selection

The best time to get in touch with me by phone is:

morning (8AM to 12PM)

afternoon (12PM to 5PM)

evening (5PM to 9PM)

weekends

Clear selection

Is there anything else you want to tell us?

Submit

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