Full Name
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Email
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Phone
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Best time to call
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Phone anytime
Phone before 10 am
Phone after 10 am
Phone after 2 pm
Phone after 5 pm
Phone Saturday
How long have you lived in Nevada?
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Less than 3 months
Less than 2 years
Less than 3 1/2 years
More than 3 1/2 years
If in Nevada less than 2 years, what state did you live in before?
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What is the main reason you are considering Bankruptcy?
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Foreclosure is Pending
Wages are being Garnished
Lawsuit is Pending
Back Income Taxes Owed
Creditor Harassment
Large Amount of Debt
Other – Please Explain
If other please explain
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How many people are in your household (include yourself)?
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What is your gross (before taxes are taken out) yearly income?
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Under $45,000
Under $55,000
Under $60,000
Under $65,000
Under $70,000
Over $70,000
If married, what is your spouse's gross yearly income?
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Separated or not married
Under $45,000
Over $45,000
If married, what is your combined gross yearly income?
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Separated or not married
Under $55,000
Under $60,000
Under $65,000
Under $70,000
Over $70,000
How much do you owe for credit cards medical bills and other debt not tied to property being financed?
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Under $15,000
Under $25,000
Under $50,000
Under $100,000
Over $100,000
How much of the above debt is for student loans income taxes or child support?
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If you are behind on your home mortgage can you afford to (or do you want to) resume the monthly payments and try to make up the back payments?
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Yes
No
Not Applicable
How much is your first mortgage payment?
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(If you are not a homeowner, answer $0)
How much is your second mortgage payment?
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(If you are not a homeowner, answer $0)
What is the total pay off amount for all your vehicle loans?
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(If you do not owe any money for a vehicle loan, answer $0)
Are you self employed?
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Yes
No
Questions and Comments
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