Client Intake Questionnaire
What is your Full Legal Name *
Your answer
Have you used any other names in the past 8 years? Please provide all spellings and include abbreviated names like John Doe, John A. Doe, John Arron Doe. *
Your answer
What is your phone number *
Your answer
What is your Email Address *
Your answer
Have you filed bankruptcy before? *
What is your home address? Please provide the street address only below. For example 123 Main Street, Charleston, SC should only be "123 Main Street". If there is an apartment it would be "123 Main Street, Apt A" *
Your answer
What is the City for your home address *
Your answer
What is the State *
What is the zipcode? *
Your answer
Do you have a different mailing address? If so please provide.
Your answer
How many people live with you? *
Number of children living in the home and claimed as dependents on your tax return at 100%
Your answer
Have you filed all of your past tax returns. *
Which County do you live in? *
Your answer
How did you find the Markham Law Firm, LLC *
How long have you lived in South Carolina? *
What is your spouses name
Your answer
Are you employed? *
Do you have a social security card? *
Do you have a government picture ID *
Has your spouse used any other names in the past 8 years? Please provide all spellings and include abbreviated names like John Doe, John A. Doe, John Arron Doe.
Your answer
Do you own your home? *
What is your Date of Birth MM/DD/YYYY *
Your answer
Do you own a car? *
If you own a car what is the make, model, year, mileage, VIN, and approximate value?
Your answer
Do you own a home? *
If you own a home I need the following information: 1. Your monthly payments (or the payments last time you made them); 2. The number of months left on your mortgage; 3. the amount of arrearages (past due payments and interest); 4. the interest rate on your mortgage; and 5. your taxes and insurance for your home on an annual basis.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Markham Law Firm, LLC. Report Abuse - Terms of Service