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Law Office of John M. Given - BK INTAKE
Bankruptcy Intake Form
Email address *
Today's Date
Full Name *
Your answer
Spouses Name (if applicable)
Your answer
Address (Residence)
Your answer
How long have you lived in CA?
Your answer
Phone Number(s) *
Your answer
Is it okay to send text message to this number?
Marital Status
Do you have any Dependents? How many?
Your answer
Have you Filed Bankruptcy Before?
Your answer
What Type of Bankruptcy Do You think you want?
Are you Being Sued/Harassed
What Kind of Debt Do You Have? *
John M. Given
How much Debt do you have?
Your answer
Do you Own Real Estate?
If you own Real Estate, what type(s)
Tell me about your car(s). (Year/Make/Model/Balance/Payment)
Your answer
What are your sources of income?
What is your Typical Gross monthly income?
Your answer
What are biggest monthly Expenses, and how much? (e.g., Rent, Car Payment, Food, Gas & Transportation, etc.)
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How did you hear about us?
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A copy of your responses will be emailed to the address you provided.
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