Free Online Consultation


This is an optional, Online Ohio bankruptcy form. We can also get this information over the phone if you would rather call us. Once we have received your information, we can quickly determine if filing for bankruptcy in Ohio is an option for you. If so, we will be happy to schedule your appointment.

Please fill this form out to the best of your ability so that Mr. Brewer will be able to assess your financial situation.
This form is intended only for individuals seeking to file for bankrupty in Cleveland and Akron, Ohio and the surrounding areas.


General Information

Name
Spouse’s Name
Address
Home Phone
City in Northern Ohio
Work Phone
ZIP
eMail

Were you ever involved in any prior bankruptcy (Chapter 7 or Chapter 13)?

Yes No


Employment Information

What is your occupation?


Name and address of current Employer.
Name
Address
City
State
Zip
Pay Period

How long have you been at your current job?


If you have been at your current job less than one (1) year, describe your previous position.

What is the amount of your monthly take home after taxes?

What is your spouse’s occupation?


Name and address of current Employer.
Name
Address
City
State
Zip
Pay Period

How long has your spouse been at their current job?


If your spouse has been at their current job less than one (1) year, describe their previous position and length they were employed.

What is the amount of your spouse’s monthly take home after taxes?


Current Debt

Please provide estimates of your debt for each of the below categories.  You will be asked to provide more specific information after your initial consultation;  therefore, it is understood that the figures you provide today may change prior to completing your legal documents.
Credit Card Debt
Medical Bills
Repossession Debt
Wage Garnishment
Personal Loans
Student Loans
Other


Your Residence

If you RENT, please provide your monthly rent payment?

If you own your home and it is encumbered by a mortgage(s), please provide the following information:

1st Mortgage

Balance
Payment
Arrearage (Amount you owe for back payments.)
Name of Mortgage Company

2nd Mortgage

Balance
Payment
Arrearage (Amount you owe for back payments.)
Name of Mortgage Company

What is the estimated value of your home?


To find out what homes have recently sold for in your neighborhood go to www.bankofamerica.com

Have you had your home appraised?

Yes No
If YES, provide date:
 /


Your Family

List the sex and ages of all children whom you declare as dependents on your taxes:

1st dependent
2nd dependent
3rd dependent
4th dependent
5th dependent

Your Vehicles

Do you have a vehicle(s)? If YES, complete the following:

1st Vehicle

2nd Vehicle

Type of vehicle vehicle
Year
Make
Model
Mileage
Check if paid in full.

I am financing the purchase of my car.

Monthly payment
Past due amount
Balance (pay off)

I am leasing my vehicle.

Monthly payment
Past due amount

Thank you very much for completing this information.


Mr. Brewer will not divulge any information submitted here to any third party for any reason.