Bankruptcy Enquiry Form image.
Connecticut Residents: You may fill out the following financial information, and we can help you decide whether filing for bankruptcy appears to be the right course for you. We can also provide information on bankruptcy costs. This is not a complete interview, and any recommendation based on this form is preliminary. We cannot make a recommendation prior to meeting with you and discussing your personal situation in detail.

If you prefer, you may download this form in an Adobe Acrobat .PDF file, and mail/fax to us. Click here for the download. You must have the free "Acrobat Reader" to open the file. Follow this link to download the reader.

You may also print out and fax this form to: Bankruptcy Law Group at 860-236-0050.
Your Name:
Home Phone Number:
Work Phone Number:
Cellphone Number:
Best Time to Contact You:
Email Address:
How would you like us to contact you?:
Please tell us about your debt:
Do you own a house?:
WHAT PROPERTY ASSETS DO YOU OWN?:  
House or other real estate current market value:
Mortgages on real estate:
Has the Bank started a foreclosure?:
What is the year, make & model of your car?:
Has the Bank threatened a reposession?:
Do you have a car loan?:
Describe any valuable personal property, including jewelry, collectibles and antiques:
Retirement accounts or Cash Value Insurance:
Total cash in bank accounts:
Total cash in stocks, bonds, etc.:
Any special considerations or issues you are aware of to help us help you?:
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If you prefer, you may download this form in an Adobe Acrobat .PDF file, and mail/fax to us. Click here for the download. You must have the free "Acrobat Reader" to open the file. Follow this link to download the reader.

You may also print out and fax this form to: Bankruptcy Law Group at 860-236-0050.