Firm Overview
Attorneys
Practice Areas
- Chapter 7 Straight Bankruptcy
- Chapter 13 Debt Consolidation
FAQS
Contact Us
Blog
Videos

Firm Overview
Attorneys
Practice Areas
- Chapter 7 Straight Bankruptcy
- Chapter 13 Debt Consolidation
FAQS
Contact Us
Blog
Videos

Interview Sheet Questionnaire

Please fill out this 3 page questionnaire thoroughly and completely. Thank you for your patience and cooperation.

*IMPORTANT: PLEASE PROVIDE A WRITTEN LIST OF YOUR DEBTS, INCLUDING NAME, ADDRESS & BALANCE, ALONG WITH A PHOTO I.D. (DRIVERS LICENSE), AND PROOF OF INCOME TO THE RECEPTIONIST WITH THIS COMPLETED INTERVIEW SHEET.

Date*

MM slash DD slash YYYY

Your Full Legal Name:*

Social Security No:

Spouse's Full Legal Name:

Social Security No:

Martial Status:

Married

Single

Separated

Divorced

Widowed

Mailing Address:

Street Address City State ZIP / Postal Code

Physical Address:

Street Address City State ZIP / Postal Code

Date of Birth:

MM slash DD slash YYYY

Spouse's Date of Birth:

MM slash DD slash YYYY

County

Home Phone Number:

Cell Phone Number:

Email Address:

Number of Dependent Children at Home:

Ages:

What Person or which Yellow Page or TV ad referred you to our office?*

*Important*

Home Loans

Mortgage Company:

Company

Mailing Address

MTG Pmt $/Month

Payoff Total $

Months Behind?

Approximate Market Value of Property

Year Purchased

Purchase Price

Do you rent a house?*

Yes

No

Landlord's Name

Landlord's Address

Address

Vehicles

(Please list every vehicle in your name, even if it is paid off.)

Auto

Yr/Make/Model

Purchase Date

Name and Address of Auto Loan Company

Mileage

Payoff $

Monthly payment

Are you behind on any car payments?

Yes

No

If so, how many?

Personal Information

Name of Your Employer:

Complete Address of Your Employer:

Street Address City State Zip

Occupation:

How long employed?

Work Phone:

Ext.

Name of Spouse Employer:

Complete Address of Spouse Employer:

Street Address City State Zip

Occupation (Spouse):

How long employed? (Spouse)

Work Phone: (Spouse)

Ext. (Spouse)

Monthly Household Income

Your Gross / Net Income:

Circle One:

Wkly

bi-wkly

monthly

Spouse Gross / Net Income:

Spouse Circle One:

Wkly

bi-wkly

monthly

Other Income:

Child Support:

Social Security:

Any other type of income:

Total Monthly Income:

Your Annual Income:*

2023 Income to date

2022 Income

2021 Income

Spouse Annual Income:*

2023 Income to date

2022 Income

2021 Income

Checking:

Name of Bank

Balance

Savings:

Name of Bank

Balance

Have you or your spouse ever filed for Chapter 7 Bankruptcy or Chapter 13 Debt Consolidation?

Yes

No

If so, When?

Do you owe the IRS or State of AL Taxes?

Yes

No

If so, how much and for what years?

IRS

Year

State

Year

Do you owe child support?

Yes

No

Person’s Name and Address Receiving Support:

Have you paid any creditor more than $600.00 at one time in the last 90 days?

Yes

No

Do you have any pending Lawsuits against you in the last 12 months?

Yes

No

Do you have any outstanding judgments against you?

Yes

No

Are your wages now being garnished or about to be garnished?

Yes

No

Who?

Have you had a Safe Deposit Box in the Past 12 Months?

Yes

No

Who?

Who has access?

Contents?

Have you stored property in a storage unit or place other than your home in the last 12 Months?

Yes

No

Estimated Monthly Expenses

(Rent / Mortgage / Mobile) Home

Utilities:

Electric & Gas

Water

Cable / Internet

Home Phone / Cell

Food

Medical and Dental Co-Pays & Prescriptions

Auto Insurance

Auto operating costs (gas)

Child or Spousal Support (not including if deducted from paycheck)

Daycare

Renter’s Insurance

Charitable Contributions

Property Tax (if not in mortgage)

Homeowners Insurance (if not in mortgage)

Installment Payment for:

Installment Payment Amount:

Other Misc. Living Expenses:

Other Misc. Living Expenses Amount

Total Monthly Expense:*

Notes

List of Creditors

Name

Account #

Address

Balance

List of Creditors

Name

Account #

Address

Balance

Email

This field is for validation purposes and should be left unchanged.

Δ

Office Locations

1358 Dauphin St
Mobile, Alabama 36604
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23315 Pet Drive
Robertsdale, Alabama 36567
View Map and Directions

612 Alabama Avenue,
Selma 36701
View Map and Directions

Contact Information

Mobile: (251) 432-3100
Robertsdale Office: (251) 432-3100
Selma Office: (334) 872-9280
Fax: 251-432-3182

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