Bankruptcy Evaluation

Thank you for your interest in our bankruptcy evaluation services. Please complete the form below and an attorney from our friendly office will be in contact with you. PLEASE NOTE: All fields are required. This bankruptcy evaluation is available to New Jersey residents only.

1. Your Name:
First: Last:

2. Your Email:

3. Your Zip Code:
(This evaluation is available to New Jersey residents only.)

4. Check One:
 I am single and unmarried (not just separated). I am married (or separated) and plan to file singly. I am married and plan to file jointly with my spouse.

5. How many people are in your household, including yourself?
(Include your young children, adult children who live with you, and your parents if they live with you and you contribute to their support.)

6. Please check each box pertaining to your source(s) of income:
(Include your spouse's source(s) of income if planning to file jointly.)
 Unemployed, not collecting unemployment benefits Unemployed, collecting unemployment benefits Self-employed Employed Social security/disability benefits or pension withdrawals Investments, stocks/bonds, trust account, and/or savings


7. State your weekly net (take-home) income from all sources, and include spouse's income if planning to file jointly:

8. Please state the approximate total of your unsecured, credit card, and/or medical debt:

9. Do you: (check all that apply, if you have more than one property)
 Own a home. Rent a home or apartment. Neither own nor rent.

10. Do you own or lease at least one car?
 Yes No

11. Are you current on your:



Car Loan(s):

Car Lease(s):

12. Is there anything else I should know to help me analyze your situation for you? (Please be concise, as there is a maximum of 40 characters.)

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Office Locations

Burlington County
10 North Chestnut Ave
Maple Shade, NJ 08052

Camden County
1812 Berlin Rd
Cherry Hill, NJ 08003

Office Hours by Appointment Only

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