BANKRUPTCY CONSULTATION INTAKE

BANKRUPTCY CONSULTATION INTAKE FORM

BANKRUPTCY CONSULTATION INTAKE FORM

Personal Information

Income and Expense

Please fill out the income and expense section below.
Use the “Spouse” column only if you and your spouse do not live together.

Debtor

Spouse

Gross Monthly Income

$
$

Net (Take-Home) Monthly Pay

$
$

Rent/Mortgage

$
$

Utilities

$
$

Clothing

$
$

Medical Expenses (not covered by insurance)

$
$

Gasoline/Repairs/Maintenance/Registration

$
$

Auto Insurance

$
$

Support

$
$

Child Care / Day Care

$
$

Vehicles

Please fill in your Vehicles information

Vehicle #1

$

Vehicle #2

$

Vehicle #3

$

Vehicle #4

$

Property Details

Please fill in your property details

Property #1

$

Amount owed to all mortgage lenders: (1st, 2nd, and 3rd)

$
$
$
$

Property #2

$

Amount owed to all mortgage lenders: (1st, 2nd, and 3rd)

$
$
$
$

Property #3

Amount owed to all mortgage lenders: (1st, 2nd, and 3rd)

$
$
$
$

Other Information

Please fill in the details

Please estimate dollar amount of your unsecured debt:

$

Following your initial interview, if you agree to hire the firm, and the firm agrees to represent you, both you
and the firm will sign a Fee Agreement. The Fee Agreement will set forth the terms and conditions of
representation.
If the firm is willing to represent you and you decide not to sign a Fee Agreement today, you are strongly
urged to schedule a second appointment at the earliest possible time or to immediately consult with other
legal counsel to protect your rights. There may be some time limitations concerning your matter.
NOTICE: This office does not represent you with regard to the matter set forth by you in this information
sheet or discussed during your consultation until both you and this office sign a written Fee Agreement.
Your signature acknowledges only that you have received a copy of this completed information sheet and
does not mean you have retained our office to handle your legal matter.

Sign Here

COVID-19: Your safty is our priority.Amidst the COVID-19 outbreak, we are doing our part to keep our clients and team members safe and healthy. The wheels of Justice are still moving, but you can stay at home while we fight for you. Learn More about the precautions TomHoganLaw firm is taking to minimize the speed of COVID-19 and read more about FAQ regarding how outbreak would effect your case.
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