Bankruptcy Evaluation Is Filing Your Best Next Step? Confidential, no-obligation Bankruptcy Evaluation. Results available within 72 hrs. Bankruptcy Evaluation Is Filing Your Best Next Step? Complete the form below to receive a free, confidential, no-obligation Bankruptcy Evaluation within days. Submitted forms are analyzed by our experienced Bankruptcy attorneys and results are available within 72 hours. GENERAL INFORMATION Your Name (required) Phone Number (required) Email Address (required) Street Address (required) City (required) State (required) Zip (required) How long have you been a resident of Florida?Have you ever filed for Bankruptcy?YesNoIf yes, in what month and year did you file?Are you currently married?YesNoHow many people live in your home? FINANCIAL INFORMATION What is your GROSS monthly income (i.e. before taxes)?What is your NET monthly income (i.e. after taxes)? What is the total amount in all of your bank accounts?Do you owe money to any bank where you have an account? (e.g. car loan, home loan)YesNoWhat is the total of your Unsecured Debt? (e.g. credit cards, medical bills, personal loans, etc.) ASSETS REAL ESTATE Is there a mortgage on your home?YesNoIf you have mortgage, are you current on your payments?YesNoIf you have a mortgage, what is the current payoff amount?Do you own real estate other than your home?YesNo AUTOMOBILES VEHICLE #1 Make, Model, Year (e.g. Ford Expedition 2015)Current ValueBalance OwedAre you current on payments?YesNo VEHICLE #2 Make, Model, Year (e.g. Ford Expedition 2015)Current ValueBalance OwedAre you current on payments?YesNo VEHICLE #3 Make, Model, Year (e.g. Ford Expedition 2015)Current ValueBalance OwedAre you current on payments?YesNo OTHER SIGNIFICANT PROPERTY (e.g. STEREO, ARTWORK, etc.) Brief DescriptionEstimated Value Brief DescriptionEstimated Value Brief DescriptionEstimated Value Brief DescriptionEstimated Value AVERAGE MONTHLY EXPENSES Mortgage/RentElectricityWater/SewerPhone Food/GroceriesMedical/DentalTransportation/GasHealth Insurance Life InsuranceAuto InsuranceRecreationCharitable Contributions Alimony/Child SupportAuto LoansOtherOther How would you like to receive the results of your evaluation?By PhoneBy EmailBy Regular Mail NOTICE: By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.