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