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Do You Qualify to File Bankruptcy?

Please complete all information as fully as possible.
Our bankruptcy lawyer will review it and let you know
if you qualify to file.

NOTE: JavaScript is required to use this form.

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Debt Type
Credit Cards
Medical Bills
Judgements
Student Loans
Tax Debts
Personal Loans
Judgement Details Number of Bills:
Amount:
Additional Notes:
Medical Bills Details Number of Bills:
Amount:
Additional Notes:
Credit Card Details Number of Bills:
Amount:
Additional Notes:
Student Loan Details Number of Bills:
Amount:
Additional Notes:
Tax Debt Details Number of Bills:
Amount:
Additional Notes:
Personal Loan Details Number of Bills:
Amount:
Additional Notes:
Assets Do you own any of the following:
Home
Vehicle
Other
Home Details
Approximate home value:
Approximate mortgage balance:
Monthly mortgage payment:
Are you up to date on your
mortgage payments?
Are there any other mortgages
on this property?
$
$
$

Yes No



Yes No
Income Are you employed? Yes No

What types of income do you have?

(Check all that apply)
Disability         Child Support
Social Security Unemployment
Pension           Worker's Compensation
Rental Income
Income Details Please tell us about your household income:

You
How often do you get paid?
every week
every 2 weeks
twice a month
monthly
Net Pay     $
(after taxes, medical, and other deductions)
Spouse (Optional)
How often do you get paid?
every week
every 2 weeks
twice a month
monthly
Net Pay     $
Payment every 2 weeks occasionally results in a 3rd paycheck, as opposed to being paid 2x a month.
Wrap Up Test