Required Client Forms

Complete the applicable form below. Your progress saves automatically on this device, and you can review everything before printing, saving, or preparing an email to the firm.

Intake Progress
Started · Autosave status: Ready
Please complete every question to the best of your ability.
If a question does not apply to you, enter “N/A” instead of leaving it blank. Approximate amounts and dates are acceptable if exact information is unavailable.
Bankruptcy Questionnaire
Important: Bankruptcy is a right provided by law to people who are deeply in debt and in need of a fresh start. Please complete all questions and list all property and all creditors. If you intentionally provide false information or omit information, it could be considered a crime. We are a debt relief agency, and we assist people in filing for bankruptcy under the Bankruptcy Code.

Please provide:
  • Federal & State tax returns for the last three (3) years
  • Paystubs for the last six (6) months
  • Social Security, Retirement, Benefits, Pension, award letter for current year
  • Color copy of Driver License
  • Last three (3) months of bank statements for all active accounts
Name and Residence InformationSection 1
Prior BankruptcySection 1a
Have you ever filed or were involved in a prior bankruptcy?
Have you had a previous bankruptcy discharge within the last 8 years?
Property InformationSection 2
Rental PropertySection 2a
Do you have rental property?
Mobile Home & Land InformationSection 3
Other PropertySection 4
Personal Property: Active Bank AccountsSection 5a
Financial InstitutionTypeAccount #Current Balance $Remove
Other Financial InformationSection 5b
Household Furnishings / Jewelry / Insurance / RetirementSections 5c-5d
Motor VehiclesSection 5e
Make / Model / YearVIN / MileageFinance Co.Payment $Payoff $Insurance / CoverageRemove
IncomeSection 6
ExpensesSection 7
OtherSection 8
Tax Debt / Student LoansSections 8.14-8.16
Do you have student loans?
Have you co-signed student loans for someone else?
Total Mortgage/Vehicle Payoffs Entered$0.00
Total Bank Account Balances$0.00
Total Personal Property Values Entered$0.00
Estimated Monthly Household Income$0.00
Estimated Monthly Household Expenses$0.00
Estimated Monthly Difference$0.00
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Creditor Information Sheet
Bankruptcy Creditor Sheets
Please list each creditor separately. Use the “Add Creditor” button as many times as needed.
Total Creditors Listed0
Total Amount Owed$0.00
Total Monthly Payments$0.00
Business Questionnaire
For Self-Employed Clients Only.
Please complete all applicable business information below regarding your self-employment, LLC, corporation, or independent contractor business activity.
Business InformationPage 1
Are you presently self-employed?
Is this business incorporated?
Do you have any employees?
Do you have any W-2 employees?
Are you current in payroll taxes?
Business Assets / InventoryPage 2
Do you have accounts receivable?
Do you have any inventory?
Does your business owe any federal or state taxes?
Business Records / InsurancePage 2
Do you have a current business license?
Do you have business liability insurance?
After your case is filed, do you believe you will incur additional credit or debt?
Important NoticePage 3
Self-employed debtors may not take certain actions without specific court authorization, including use of cash collateral, hiring professionals post-petition, payment of certain pre-petition debts, borrowing money, or selling property outside the ordinary course of business. You are responsible for maintaining adequate business records and required insurance.
Profit & Loss Statement
For Self-Employed Clients Only.
Enter the monthly business income and expenses below. The form will automatically calculate Cost of Goods Sold, Gross Profit, Gross Income, Total Expenses, and Total Profit or Loss.
Monthly Profit & Loss Statements
DeclarationSignature
I/we declare under penalty of perjury that the information provided is true and correct to the best of my/our knowledge, information and belief.