* 1. Please fill out the questions below and provide your first and last name, email and phone if you would like to be entered to win $100. Thank you, we appreciate your responses!

* 2. 1) Are you concerned about the amount of debt that you are currently carrying?

* 3. Are you able to pay all of your bills every month?

* 4. How do you view the direction of your ‘financial health’ over the last two years?

* 5. Has the idea of filing bankruptcy or seeking advice from an attorney ever occurred to you?

* 6. If you answered Yes, what would be the primary thing you would be looking for:

* 7. What would be your primary reasons for calling a bankruptcy attorney?

* 8. What would be the reasons that would prevent you from seeking advice from a bankruptcy attorney? (check all that apply)

* 9. Would you like to be confidentially contacted by Wink & Wink for a complimentary consultation about the options available to you? If so, please indicate the best way to contact you.

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