Bankruptcy Questionnaire

Your Full Name (required)

Date of Birth (required)

Your Phone (required)

Your Email (required)

Your Street Address

Your City

Your State

Your Zip Code

Amount of unsecured debt

Are you employed? YesNo

Total NET household monthly income

Do you own real estate? YesNo

Do you rent? YesNo

Do you own an automobile? YesNo

Do you owe taxes? YesNo

Do you owe child support? YesNo

Do you owe student loans? YesNo

Have you ever filed for bankruptcy before? YesNo




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“I would highly recommend Jeffrey Freedman’s office. My attorney was very informative, explaining everything in detail. He was also very kind and courteous.”

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KENMORE, NY
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