Attorney Eric S. Ruff Attorney Lisa C. Cohen Gainesville Bankruptcy Attorney
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Florida Bankruptcy Online Case Evaluation

After you submit this form we will contact you with a free consultation. Answer as many questions as you can.

Contact Info:

Full Name
Marital Status
Address
City
State
Zip
Best phone to reach you
Next Best Phone Number
Best Time to Call
Email Address
Please approximate all dollar amounts

If you are buying a home (or home is fully paid for):

Value of home
Balance of all mortgages on the home
Amount you are behind on your house payments?

Debts:

Total owed on credit cards, medical bills, repo's
Hospital & Doctor Bills
Repo Balances
Judgements

Income:

Are You Employed?
If you are married, is your spouse employed?
How many people live at your home? (Include children you claimed as
dependants on your last tax return)
Total Monthly household income (before taxes)
How much of that income is Social Security?

Vehicle 1:

Year/Make/Model
Value in current condition
Balance owed on Vehicle
Amount behind in payments

Vehicle 2:

Year/Make/Model
Value in current condition
Balance owed on Vehicle
Amount behind in payments

Residency:

Lived in Florida coninuously for the last 24 months
Lived in current County continuously for 91 days

Anything else you want to tell us:

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