Painting by Sabrina Laumer

Case Evaluation 


COMPLETE before a consultation or fee quote

 

Prior Bankruptcy?
If yes, date:
If yes, date:
Full Name
Full Name
Spouse's Name
Spouse's Name
Home Phone
Home Phone
Cell Phone
Cell Phone
Spouse's Cell Phone
Spouse's Cell Phone
Do you live in separate households?
Household Information
Dependents?
Income
Are you a sole proprietor, shareholder, partner or investor in any business(s)?
Please enter estimated amounts for following if you or your spouse:
Receive unemployment?
Receive Social Security?
Receive a pension check?
Have an annuity?
Pay child support?
Receive child support?
Have another income (for example: rentals, oil/gas royalties, gifts)
Have you made a distribution(s) from a 401K or IRA in the last 7 months?
Do you have interest in a trust?
Real Estate
Do you have a mortgage?
If yes, are you current on payments?
If not current, can you catch up arrears within a month or so?
Do you own rental property?
Do you own land/lot(s)/any other interest(s) in land?
Do you rent?
Vehicles, boats, trailers, etc
Are you current on vehicle payments?
Banking Information
Assets
Retirement Account(s)
Stock
Savings
Other(describe)
Debts
Are your debts primarily
Is any loan secured by household items?