Bankruptcy Evaluation

Your Name (required)

Your Email (required)

Which of the following has happened to you RECENTLY?(select all that apply)
 Creditor Harassment Disability or Illness Divorce Foreclosure Lawsuits of Judgments License Suspension Loss of Income Loss of Job Repossession Other

What is your Est. Total Debt

What kind of bills do you CURRENTLY have?(select all that apply)
 Auto Loans Child Support Credit Cards or Charge Cards Income Taxes Medical Bills Mortgage or Rent Payday Loans Other

Est. Total Monthly Bills

Do you own a house?  Yes No

If Yes, are you behind in these payments?  Yes No

Do you own a car, truck or motorcycle?  Yes No

If Yes, are you behind in these payments?  Yes No

Other assets:
Tip: If you own other assets not mentioned above, please list them in the box.

What are your CURRENT sources of income ?(select all that apply)
 Full-time job Part-time job Social Security Pension or Retirement Child Support Payments Dividends or Interest I currently have no income Other

What is your Est. Total income

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