FORM 1 - CLIENT QUESTIONNAIRE
BACK TO ON-LINE FORM

This is the first form required by the Bankruptcy Court to initiate your bankruptcy case.  Complete all boxes with the information requested, then use the submit button once to send the information to us.  Alternatively, you can hit the browser print button to print a hard copy for your records before you submit it, or to bring with you to our offices.

IMPORTANT: if filing Joint application, please enter husband's information first.

PART A.  NAME AND ADDRESS
Last Name
First Name
Middle Name
Home Phone
Work Phone
Your E-mail
Have you used any other names in the past six years?  no   yes  If yes, list other names
Other Names
Social Security #
Address
City        State         Zip 
Country
Have you lived at this address for at least 180 days?    no    yes
If you have a different Mailing address please list
Mailing Address
City           State         Zip    

PART B. NAME AND ADDRESS OF SPOUSE
If you are filing jointly with your spouse, fill in the following information about your spouse
Name        Last   First Middle
Has your spouse used any other names in the past six years No  Yes If yes, list others
Other Names
Social Security #
 Address   (if different from your address) 
City           State      Zip 
If your spouse has a different mailing address, please list
Address
City        State        Zip

PART C.  PRIOR/PENDING BANKRUPTCY CASES
Has a bankruptcy case been filed by you or against you in the last 6 years?    No Yes
If yes, in which district of which state was the case filed? 
Case Number          Date Filed  
Are there currently any bankruptcy cases pending against you, your business, your spouse, or your spouse's business?       No   Yes
If yes, name of debtor     Relationship to you
Case Number     Date Filed Judge

Important Notice Please Read! 

Please click the "Submit" button only once! 

This form takes a few moments to process.   Please make sure you have entered a valid e-mail address to ensure this form is submitted correctly.  

If you are unsure or received an error message, please call us at 801-501-0100.