Video Call Consultation Forms

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Cell Phone (Your Number for Video Call) *

Home Phone

Email *

Are you a citizen or legal resident of the United States? *

Yes
No

You must be a citizen or legal resident of the United States with a valid social security number in order to file bankruptcy.

Last 4 digits of Social Security Number

You will be required to provide your Social Security Card at a later time.

Marital Status *

Spouse's Name *

First

Last

Is your spouse also filing with you?

Spouse's Email *

How Many People Are In Your Household?

Identification Verification - Please upload a photo of your driver's license(s) (and Social Security Cards) *

Click or drag files to this area to upload. You can upload up to 2 files.

Please provide a copy or image of your (and your spouse's) driver's license.

Your Debt Sources & History

If you are married, please include your spouse's debts also.

Debt Sources - Please check all that apply

How much total debt do you have? (please provide an estimation)

Are any of your creditors suing you?

Yes
No

Which creditor is suing you?

What county are you being sued in?

Example: Marion County, Boone County, Hendricks County, Hamilton County

Are you being garnished?

Yes
No

Which creditor is garnishing you?

We want to make a plan to get that garnishment stopped through this process.

Do you rent or have a mortgage?

Rent
Mortgage
Neither

Are you current on your rent or mortgage?

If you are behind on rent or mortgage, what amount are you behind?

Do you own real estate or are you on the deed to someone else's real estate?

Yes
No

Briefly describe all forms of real estate that you own or in which you may be entitled to in some form.

Examples: My home, my rental property, I am on the deed to my mother's house, I have real estate entitled to me through an inheritance, etc.

Have you filed for bankruptcy before?

What year did you file bankruptcy in the past?

Employment & Income

If you are married, please include your spouse's income also.

What is your employment status?

Employed
Unemployed
Social Security Disability

What is your estimated income amount per year?

Please upload a copy of your most recent paycheck stubs.

Click or drag files to this area to upload. You can upload up to 6 files.

PDF or JPG

What is your spouse's employment status?

Employed
Unemployed
Social Security Disability

What is your spouse's income amount per year?

Vehicles

How many vehicles do you have?

More Information

Does anybody owe you any money? Or can you sue anybody for anything? Or do you have trust, inheritance, annuity, or any other source whre money could be owed to you? If yes, please explain below. *

Are you facing a dire collection situation right now? (such as a lawsuit, garnishment, repossession, foreclosure, or sheriff sale) Please provide the details below:

By typing my name below I attest that all information provided is true and accurate *

Date *

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Affordable Indiana Debt Relief

Video Call Consultation Forms

Video Call Quick Questionaire

Your Debt Sources & History

Employment & Income

Vehicles

More Information

FREE Consultation – Get Debt Free!

Free Bankruptcy Guide

Free E-Books

Client Tools

Free
Bankruptcy
Guide

Free
E-Books

Client
Tools