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1.
What is your full, legal name?
(Required.)
2.
Have you used any other name in the past 8 years? If so, list below.
3.
What is the best phone number to reach you at?
(Required.)
4.
What is the best email to send documents to?
(Required.)
5.
How did you hear of us?
Online
Received a letter
Referred by a friend/family
Other (please specify)
6.
Have you had a prior consultation with us?
Yes
No
7.
What is your present address?
(Required.)
Street Address:
City, State Zip:
8.
What county do you live in?
Allegan
Barry
Ionia
Kalamazoo
Kent
Montcalm
Muskegon
Ottawa
Other (please specify)
9.
What is your SSN?
(Required.)
10.
What is your date of birth? (MM/DD/YYYY)
(Required.)
11.
Have you filed Bankruptcy in the past 8 years?
(Required.)
Yes
No
12.
Briefly describe the circumstances which led you to consider bankruptcy.
13.
Are you presently employed?
(Required.)
Yes
No
