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Telephone Consultation Information Form

 The following information is REQUIRED for a telephone consultation. Please complete this form. Then call 585-425-1060 for a telephone consultation. All information contained in this form is subject to attorney client privilege and will be used solely for the purpose of evaluating your financial situation.

For more information, view our Privacy Policy
 
Name:
Street Address:
City:
State:
Zip Code:
 
Phone - Days:
Phone - Evenings:
Email Address:
 
Marital Status:
Employer:
Job Title:
Monthly Household Income (All Sources):
 
Do you own or rent your home?: Own     Rent
What's the approximate value:
Total amount of all mortgages:
 
List all vehicles in your household:
Total amount of credit card debt:
Taxes - Amount Due:
Taxes - Type:
Do you have any student loans: Yes    No
Please describe why you believe you are in need of bankruptcy assistance:

Once you have completed this form you must sign our retainer agreement.

Click the "Retainer Agreement Button" to continue

 

 

Form Status
Telephone Consultation Not Complete
Retainer Agreement Not Complete

 

  

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