Home
Bankruptcy
Chapter 7
How Chapter 7 Works
Chapter 7 Eligibility
Role of the Case Trustee
Where is the Courthouse?
Chapter 7 Discharge
Chapter 13
How Chapter 13 Works
Plan and Confirmation Hearing
Where is the Courthouse
Making the Plan Work
Chapter 13 Discharge
Other Services
Medical Bills
Credit Card Debt
Repossesion
Free Evaluation Form
Free Evaluation Form
Step
1
of
5
20%
Today's Date
*
MM slash DD slash YYYY
Name
*
First
Last
Phone
*
Your Current Email Address
*
Enter Email
Confirm Email
DEBTS
Please List as much as you can in this section
Approximate Credit Card Debt
*
Please Choose
Under $5,000
$5,001 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45.000
$45,001 - $50,000
Over $50,000
Approximate Medical Bills
*
Please Choose
Under $5,000
$5,001 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45.000
$45,001 - $50,000
Over $50,000
Approximate Student Loans
*
Please choose
Under $5,000
$5,001 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45.000
$45,001 - $50,000
Over $50,000
Approximate Tax Debts
*
Please choose
None
Under $5,000
$5,001 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45.000
$45,001 - $50,000
Over $50,000
Approximate Personal Loans
*
Please choose
None
Under $5,000
$5,001 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45.000
$45,001 - $50,000
Over $50,000
Judgements
*
Please choose
None
Under $5,000
$5,001 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45.000
$45,001 - $50,000
Over $50,000
Pay Day Loans
*
Please choose
None
Under $5,000
$5,001 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45.000
$45,001 - $50,000
Over $50,000
Other (please explain)
ASSETS
Please List as much as you can in this section
Real Estate
*
Yes
No
Value $
Balance $
Motor Vehicle 1
*
Yes
No
Value $
Balance $
Motor Vehicle 2
*
Yes
No
Value $
Balance $
Any Other Assets Worth More than $500
*
Yes
No
If Yes, Please Describe?
INCOME
Please fill in your approximate income, do your best to be as accurate as you can? Thanks!
Full Time Employment - You and Your Spouse
*
Yes
No
Total Amount $
*
Part Time Employment - You and Your Spouse
*
Yes
No
Total Amount $
*
Child Support - You and Your Spouse
*
Yes
No
Total Amount $
*
Social Security - You and Your Spouse
*
Yes
No
Total Amount $
*
Pension / Retirement - You and Your Spouse
*
Yes
No
Total Amount $
*
UnEmployment - You and Your Spouse
*
Yes
No
Total Amount $
*
Other (please explain)
Total Amount $
*
Conditional Statement
By Clicking Below you agree that the information filled in the form pages are correct to your best knowledge. You agree to receive a phone call to the number specified on our Free Evaluation Form from one of our friendly specialists. Once we receive your form we will contact you promptly between the hours of 9AM and 5PM EST.Best Regards,Edward P. Jackson P.A.
Please Fill in the Fields
Phone
This field is for validation purposes and should be left unchanged.
