Initial Consultation

This form does not obligate you to file bankruptcy nor does it create an attorney client relationship.  When you have completed the consultation form below acknowledge the required notices and press "Submit" to send us the form.  If you have not done so already, call my office for an appointment, or at the end of this form you may let us know when to contact you and we will call you and schedule an appointment.  Tell the secretary that you want to schedule your initial bankruptcy appointment with the attorney.

INITIAL BANKRUPTCY CONSULTATION FORM CLIENT INFORMATION   Home Phone:   Work Phone: Name: (First) (Full Middle Name) (Last) Name of spouse: (First) (Middle Name) (Last) Will your spouse be filing bankruptcy with you? YesNoHaven't decidedNot married Current Address: City: State: ALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVIVAWAWVWIWY Zip: Spouse Address: City: State: ALAKAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVIVAWAWVWIWY Zip: Have you ever filed bankruptcy before? YesNo Has your spouse ever filed bankruptcy before? YesNo How long have you lived in Kansas? How long has your spouse lived in Kansas? How many people live in your home even if they are not related to you? Adults Minors Are you currently employed? YesNo What are your total gross wages (wages before any deductions) for the last six months, including second or part-time jobs? Do you have any other income in the last six months? (Child support, social security, business income, etc) YesNo If yes, how much? Is your spouse currently employed? YesNo What are your spouse's total gross wages for the last six months, including second or part-time jobs? Did your spouse have any other income in the last six months? (Child support, social security, business income, etc) YesNo  If yes, how much? Do you have a mortgage, contract for deed, lease to own? YesNo Do you have a vehicle loan or any other loan that is secured? YesNo

ACKNOWLEDGMENT OF RECEIPT OF NOTICES REQUIRED BY LAW I acknowledge that I have read the following notices (click the links to see the notice): REQUIRED TO SUBMIT Self/Spouse Notices Required by Law: 342(b) , 527(a)(2) and 342(b)(2) , 527(b) , and 528

Before you can proceed, please enter the letters and numbers from the picture on the right.  This is to prevent automated systems from attempting to use this system.