Free Evaluation Form

EVALUATION FORMStep 1 of 4

Why are you considering bankruptcy?
(Check all that apply)

Garnishment Creditor Harassment
Repossession Foreclosure
Lawsuits Illness/Disability
Divorce Loss of Income

What debts do you have?
(Check all that apply)

Credit Card Medical Bills
Student Loans Personal Loans
Tax Debts Government Fines

EVALUATION FORMStep 2 of 4

Home - Do you own real state?
Yes No

Are your mortgage payments up to date?
Yes No

Vehicle - Do you have a car?
Yes No

Are your car payments up to date?
Yes No

Do you have any additional assets worth more than $1,000?
Yes No

Are you employed?
Yes No

EVALUATION FORMStep 3 of 4

Estimate total debt:

Do you have any other type of income?
(Check all that apply)

Disability Child Support
Social Security Unemployment
Pension Work Compensation
Rental Income

EVALUATION FORMStep 3 of 4

Estimate total debt:

How often do YOU get paid:

YOUR Net Pay: $

How often does SPOUSE get paid: (OPTIONAL)

SPOUSE Net Pay: $

EVALUATION FORMStep 4 of 4

First name:
Last Name:
Email:
Street Address:
City:
ZIP Code:
State:
Phone number - - Please select a time for one of our representatives to contact you to review your rights:
Time:

At Client First Bankruptcy, we are committed to your privacy . By submitting your information, you agree the phone number you provided may be used by Client First Bankruptcy and its attorney network to contact you (this may including autodialed, pre-recorded calls or text messages). Consent is not a condition of purchase or hiring our firm.