CLIENT PRE-MEETING INTAKE – OPTIONAL

Your name

Your email

Telephone

Reason(s) for Contact:
ForeclosureCredit CardMedical BillsAuto RepossessionLawsuitGarnishmentBank Freeze

Amount of Debt (Guestimate)

Have you filed for Bankruptcy in the past 8 years?:
YesNo

Married?
YesNo

Children/Dependents?
ZeroOneTwoThreeFourFive or more

What is your income?

Do you own Real Estate? (optional)

Do you own a Car(s)? (optional)

Do you own any Antiques/Collectibles? (optional)

Do you have a right to sue any person or company for injury or money? (optional)

Do you own Stocks/Bonds/Investments? (optional)

Life Insurance? Whole or Term? (optional)

Have you received or expect and Inheritance soon? (optional)

Pay back debt to Family or Friends in the past year? (optional)

Have you sold or transferred any Property in the past 2 years? (optional)

Any Additional Information you would like to add (optional)