Bankruptcy Evaluation & Questionnaire Forms | Machi & Associates

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(817) 335-8880 (tel:+18173358880) (http://machilaw.com/)

If you are considering filing bankruptcy, you may download our bankruptcy questionnaire. Completing this form before meeting with us will aid us in discussing your options. If you have spoken with us already, we may have asked you to complete this form. View/Download Bankruptcy Questionnaire (PDF) (http://machilaw.com/wpcontent/uploads/2017/09/bankruptcy_form.pdf) View/Download Bankruptcy Questionnaire (Word .docx) (http://machilaw.com/wpcontent/uploads/2017/09/bankruptcy.docx)

If you haven’t spoken with someone in our office, but would like to complete an online evaluation of your situation, see our bankruptcy evaluation form. Submitting your information on this secure online bankruptcy evaluation is the quickest way to get a good idea if bankruptcy might be a good idea for you. It is a good starting point to determine if you qualify. Completing this form does not commit you to anything.

Tell us the type of debts you have. Do not include mortgages, car loans, or boat loans here. Do you have any credit card debt? * Yes

No

If yes: # of Credit Cards Total Amount Owed ($)

Do you have any unpaid loans? * Yes

No

If yes: # of Loans Total Amount Owed ($)

Do you have debt on any medical bills? * Yes

No

If yes: # of Medical Bills Total Amount Owed ($)

Do you have any tax debt? * Yes

No

If yes: Total Amount Owed ($)

Do you have any outstanding judgements? * Yes

No

If yes: Total Amount Owed ($)

Do you have any other debt? * Yes

No

If yes: Total Amount Owed ($)

Tell us about your assets. Do you own a home? * Yes

No

If yes: Monthly Mortgage Payment ($) Estimated Mortgage Balance ($) Estimated Home Value ($) # Months Behind in Payments

Do you own a car? * Yes

No

If yes: Monthly Payment ($) Estimated Balance ($) Estimated Car Value ($) # Months Behind in Payments

Do you own a second car? * Yes

No

If yes: Monthly Payment ($) Estimated Balance ($) Estimated Car Value ($) # Months Behind in Payments

Do you own a boat? * Yes

No

If yes: Monthly Payment ($) Estimated Balance ($) Estimated Boat Value ($) # Months Behind in Payments

Do you have other assets? Please describe any other assets you may have

Tell us about your income. Fill out sources of income. Your Income: How often are you paid? * --Amount Paid ($)

Spouse's Income (leave blank if no spouse): How often is your spouse paid? --Amount Paid ($)

Other Income: Explain amount and sources of other income

Please provide us your basic contact information so we may get in touch with you. First Name

Last Name

Address

Apt, Suite #

City

State

Zip

Email

Phone How did you find our website? ---

I agree to the terms.

Submit Evaluation

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NEARLY 40 YEARS IN NORTH TEXAS For nearly 40 years, Ted Machi has helped the litle guy in the DFW metroplex through effective,determined, professional representation. Our professional team of attorneys and staff provide the experience and expertise needed to effectively handle your case.

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Last Name

E-mail

Phone

Message

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Arlington, TX 76011

bankruptcy relief under the bankruptcy code.

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Mansfield, TX 76063

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Bankruptcy Evaluation & Questionnaire Forms | Machi & Associates

(817) 335-8880 (tel:+18173358880) (http://machilaw.com/) If you are considering filing bankruptcy, you may download our bankruptcy questionnaire. C...

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