The Law Office of Michael J. Pledger

* Last Name:

* First Name:

Middle Name:

Address:

City, State & Zip

Home Telephone:

Office Telephone:

Cell Phone:

Fax:

* Email

Which of the above way(s) of contact do you prefer?:

Home
Office
Cell
Email

Are you married?

Yes
No

Your debt: Please click on the correct answer and fill in all the blanks that apply to your case.

Which of the following debts do you owe?

Home Mortgage
Car Payment #1
Car Payment #2
Student Loans (most student loans cannot be eliminated by bankruptcy)
IRS back taxes
State taxes
Credit card debts
Department store debts
Medical Bills
Boat, motor and or trailer
Lawsuits
Judgements
Real estate back taxes
Child Support
Other debts not included above.

Home Mortgage: Any arrears?

Yes
No

Home Mortgage: How many months behind?

Car Payment #1: Any past due payments?

Yes
No

Year & type of car 1

Car Payment #2: Any past due payments?

Yes
No

Year & type of car 2

IRS back taxes - what years?

State taxes: describe

Credit card debts: Approximate total amount $

Monthly Child Support $

Other debts not included above. describe

Your assets: Please click on the correct answer and fill in all the blanks that apply to your case.

Select

Which of the following assets do you own?

Home
Car #1
Car #2
Car #3
Lot or Acreage
Boat Motor or Trailer
Rent House
Savings account
Checking account
Stocks & Bonds
Tax refund currently owed to you by IRS
Any other assets worth over $1,000
IRA's or Retirement
Life insurance policies, term or whole life
Lawsuit you filed against a company or individual
Potential lawsuit against a company or individual, not yet filed

Do you intend to keep & pay your home?

Yes
No

Amount owe on mortgage $

Value of home $

Car #1 Do you intend to keep & pay your vehicle?

Yes
No

Car #2 Do you intend to keep & pay your vehicle?

Yes
No

Car #3: Do you owe money on this vehicle?

Yes
No

Savings account Approximate amount in account $

Checking account Approximate amount in account $

Stocks & Bonds Approximate value $

Income tax refund amount currently owed to you by IRS $

Any other assets worth over $1,000: describe

IRA's $

Retirement $

Income. Please click on the correct answer and fill in all the blanks that apply to your case.

Income

I am currently employed
I have a spouse who is currently employed?
I am currently receiving social security or retirement.
I or my spouse is receiving child support.
I receive any other income.
I own a business.

How much do you bring home monthly in wages(net)$

How much does your spouse bring home monthly $

Social security or retirement: If yes, how much a month $

Child support: How much a month? $

Other income. Please describe

Name of business

Type of business

Incorporated

Yes
No

DBA

Yes
No

Partnership

Yes
No

Michael Pledger will review your interview sheet and contact you for a free consultation. Thank you for filing out this sheet. I look forward to communicating with you. To send this interview sheet for my review, please click on "submit" below.