For faster response, please complete this quick questionnaire:
Reason for bankruptcy:
Loss of Job Marital Problems Credit Card Debt Medical Bills Other
Are you currently employed? Yes No Annual household income: Please make a selection no income $1-$5,000 $5,001 to $10,000 $10,001 to $40,000 More than $40,000
Do you own a home? Yes No Estimated Value: Amount Owed: Behind on Payments?: Yes No
Do you own a car? Yes No Estimated Value: Amount Owed: Behind on Payments?: Yes No
Do you have credit card debt? Yes No
Last time used? Please make a selection within the past 30 days 30 to 60 days ago 60 to 90 days ago more than 90 days ago Last payment: Please make a selection within the past 30 days 30 to 60 days ago 60 to 90 days ago more than 90 days ago Amount Owed: Behind on Payments? Yes No
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