Bankruptcy - Law Office of Jonathan Petersen

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WHAT ARE THE BENEFITS OF BANKRUPTCY?

Chapter 7

Chapter 13

Life After Bankruptcy

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Bankruptcy Evaluation Form

Please fill out the following bankruptcy evaluation form and then click "Submit." Your information will be reviewed and you will be contacted by the Law Office of Jonathan Petersen.



* Full Name
* Address
* Phone
* Email Address
* Best time to contact you?
What type of bills do you have?
(Check all that apply) 		Credit Cards
Medical Bills
Judgments
Student Loans
Tax Debts
Government Fines
Personal Loans
Number of bills
Amount Owed: Under $5,000
$5,000 - $10,000
$10,000 - $25,000
$25,000 - $50,000
$50,000 - $100,000
Over $100,000
Approximate value of home: $
Approximate balance on
mortgage: 		$
Monthly mortgage payment: $
Are you up to date on your mortage payments? Yes   No
Are there any other mortgages on this property? Yes   No
Vehicle 1
Year/Make/Model:
Approximate Value: $
Approximate Balance: $
Monthly Payment: $
Are your payments up to date? Yes   No
Vehicle 2
Year/Make/Model:
Approximate Value: $
Approximate Balance: $
Monthly Payment: $
Are your payments up to date? Yes   No
Enter any other property of significant value.
(For example, if you own a boat, list it here.)
You
Are you employed? 		employed   No
How often do you get paid? every week
every 2 weeks
twice a month
monthly
Net Pay:
(after taxes, medical and other deductions) 		$
What other types of income do you have?
(Check all that apply) 		Disability
Social Security
Pension
Rental Property
Part-time Job
Child Support
Unemployment
Worker's Compensation
Spouse (optional)
How often do you get paid? 		every week
every 2 weeks
twice a month
monthly
Net Pay:
(after taxes, medical and other deductions) 		$