Bankruptcy Evaluation Form Bankruptcy Evaluation Form First Name * Last Name * Email * Telephone Number * Address Statistical Information Why are you thinking about filing for Bankruptcy: [Check All That May Apply] Collection calls or letters Judgment against you Wage garnishment Payday loan Car Repossession Home foreclosure Loss of income Your Monthly Gross Income Spouse's Monthly Gross Income Total Debts Owed Are you current on most (if not all) of your monthly debt payments? Yes No If you have a car loan, list the make, model and year of the car you are financing: If you have a car loan, list the make, model and year of the car you are financing: Message Have you or your spouse hired an attorney? Yes No Payment Bankruptcy Evaluation Processing Fee: $55.00 Section Buttons I have read and agree Terms and Conditions and Privacy Policy Pay If you are human, leave this field blank.
