Consultation Form Step 1 of 5 20% Name(Required) First Middle Last Spouse Name (if applicable) Address City State Zip Code Phone Email Address(Required) Do you own any real property? Yes No Property Address How much could you sell it for today? What is the balance owed on your first mortgage? What is the balance owed on your second mortgage? What is the balance owed on your third mortgage? Are you current on payments? Yes No If not current, how much do you owe to catch up? If there is a foreclosure date, what date? MM slash DD slash YYYY Do you own any other real property? Yes No Do you own a motor vehicle? Yes No Vehicle Make Vehicle Model Vehicle Year When did you purchase this vehicle? MM slash DD slash YYYY How much could you sell it for today? If you have a loan on the vehicle, how much do you owe? Are you current on payments? Yes No Do you own any other motor vehicles? Yes No How much debt do you have in medical bills? How much debt do you have in credit card debt? How much do you owe to family members? How much debt do you owe to collections? How much money do you owe to payday loans? How much money do you owe for services? (security, etc) How much money do you owe for court services? (security, etc) How much money do you owe in signature loans? (Beneficial, etc) How much money do you owe for past due child support? How much money do you owe for past due taxes? How much money do you owe for student loans? I am currently unemployed Yes No My spouse is currently unemployed Yes No Name of Employer How long have you worked there? (years, months) Name of Spouses Employer How long has your spouse worked there? (years, months) How much money do you earn each month before taxes? (Gross) How much money does your spouse earn each month before taxes? (Gross) How much money do you earn each month AFTER taxes? (Net) How much money does your spouse earn each month AFTER taxes? (Net) How many people live in your household? In the last SIX months how much has your household earned total? CAPTCHA