Click here to see what items you will need to bring with you to your initial consultation.

CLIENT NAME:_______________________________

NOTE: IF YOU DO NOT PROVIDE A COMPLETE ADDRESS FOR THE ORGINIAL CREDITOR, AND THE DATE THE DEBT STARTED THE COURT WILL NOT ACCEPT YOUR CASE. IF THIS IS A CREDIT CARD DEBT, WE WILL NEED THE DATE THE CARD WAS ISSUED AND WHEN IT WAS LAST USED.

LIST OF DEBTS

MUST BE COMPLETE MUST PROVIDE

NAME AND ADDRESS OF ORIGINALCREDITOR AMOUNT OF DEBT MONTH/YEAR INCURRED

_____________________________________________ $________________ _____________

_____________________________________________ (If this is a Credit Card) Date issued _____

Date last used____________

_____________________________________________ Acct. #_____________________________________

Is this a joint account? If not, whose name is account under. ________

NAME AND ADDRESS OF COLLECTION AGENCY OR ATTORNEY COLLECTING FOR ORIGINAL CREDITOR.

_____________________________________________________________________________________________

**********************************************************************************************

NAME AND ADDRESS OF ORIGINAL CREDITOR AMOUNT OF DEBT MONTH/YEAR INCURRED

_____________________________________________ $________________ ___________________

_____________________________________________ (If this is a Credit Card) Date issued _____

Date last used____________

_____________________________________________ Acct. #_____________________________________

Is this a joint account? ________ If not, whose name is account under. ________________

NAME AND ADDRESS OF COLLECTION AGENCY OR ATTORNEY COLLECTING FOR ORIGINAL CREDITOR.

_____________________________________________________________________________________________

*********************************************************************************************

NAME AND ADDRESS OF ORIGINAL CREDITOR AMOUNT OF DEBT MONTH/YEAR INCURRED

_____________________________________________ $________________ ___________________

_____________________________________________ (If this is a Credit Card) Date issued _____

Date last used____________

_____________________________________________ Acct. #_____________________________________

Is this a joint account? ________ If not, whose name is account under. ________________

NAME AND ADDRESS OF COLLECTION AGENCY OR ATTORNEY COLLECTING FOR ORIGINAL CREDITOR.

_____________________________________________________________________________________________

This website contains general information only. This is not legal advice and it is NO substitute for a free consultation with a lawyer! No attorney-client relationship is formed until you come and see me, in person.