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BK Questionnaire Part One - Income

Please complete your personal Bankruptcy Questionnaire for Information and free consultation about your individual circumstances and unique situation.

This information is input into our bankruptcy program which will result in a print out for the court if you should decide to file. It puts all the information in the order I review it. By using this, you can see a financial overview of your particular circumstances at no charge to you.

With this evaluation in your hands, you are able to use the overall information to BEGIN your best financial route.

Regardless if you decide to file now, this information can prove very valuable for you now and in the future. You also may be privileged to help a friend or family member in these hard economic times.

Please call if you are in a hurry as soon as hit the submit button and ask directly for me, Rica - pronounced Rick-a like Ame-rica.

Information for Free Consultation & Preparation

Please note that all fields followed by an asterisk must be filled in.

How did you hear about us?

	Friends and Family
	Internet Search
	Craigslist Advertisement
	Penny Saver Advertisement

Did you filed bk in the past eight yrs?

	YES
	NO

If yes, what year?

If yes, what city, state and when

If yes, what is the case number?

E-mail Address*
E-mail Address*

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Your Full Name*
Your Full Name*

Last 4 of social ONLY (not full social)

Physical Street Address*
Physical Street Address*

City, State, Zip*
City, State, Zip*

Mailing Address including zip if different

What county do you live in?

Have you lived in this area for at least 180 days

Best Phone

List any other first, middle or last name used in the past 8 years

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Debtor's Employer Name

Debtor's Employer Address, City and Zip

Debtor's Occupation

When did you start this job?

Gross Monthly Income*
Gross Monthly Income*

Your taxes withheld monthly

Your insurance withheld monthly

Your other withholdings, if any - what? how much?

List any other source of income & amount

Expected 10 % change in income/expense in the 12 mths?

	YES
	NO

What change?

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First Name, Age, Relationship of Dependents

MARRIED/SINGLE

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SPOUSE INFORMATION FOLLOWS

Spouse's First and Last Name

List any other first, middle or last name used in the past 8 years

Last 4 of social ONLY (not full social)

Spouse's physical address, if different

Spouse's mailing address, if different

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Spouse's Occupation

Spouse's Employer

When did your spouse start this job?

Spouse's Employer's Address, City, State, Zip

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Spouse's Gross Income*
Spouse's Gross Income*

Spouse's taxes withhheld monthly

Spouse's insurance withheld monthly

Spouse's union dues monthly

Your other withholdings, if any - what? how much?

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List any other source of income & amount

Do you expect a 10% change in income in the next 12 months?

	YES
	NO

What do you expect to change? Note if spouse if so.

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Second Job Occupation (skip to end if none)

Second Job Name

Second Job Address

Second Job City State Zip

Second Job Gross Income Monthly

Second Job Taxes Withheld Monthly

Second Job Insurance Withheld Monthly

Second Job Other monthly withholdings

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Anything else you would like to say about income

NOW FOR THE EXPENSES

Are you ready for us to prepare your Bankruptcy Right Now? We will prepare it immediately upon payment. Your payment automatically puts you ahead of all other services and your case obtains priority status. Just start here Prepare my Bankruptcy NOW

Return from Bankruptcy Questionnaire (if not ready for expenses) to Home Page

If you are ready goto Get Started

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This website contains information related to law and is NOT LEGAL advice. It contents is for information only. If you need legal advice, please consult an attorney or act as your own.

All documents typed are prepared by Rica Gilmore.

SBI!