Are the Creditors Calling?
Do you need more information about your creditors and the status of your debts? Visit this site to obtain a copy of your free annual credit report.

For your convenience, we have provided this online questionnaire to allow our office the opportunity to review your financial situation, and determine if a bankruptcy consultation would be appropriate. A response will be submitted by phone or e-mail within one business day. Our office does not charge for the initial bankruptcy consultation, and we welcome the opportunity to meet with you in person to determine if a bankruptcy filing would provide an adequate solution to your financial difficulties. All information requested is kept secure and confidential, as required by the rules and regulations of the State Bar of Georgia. Submission of inquiries through our website does not create an attorney-client relationship, as the Bankruptcy Code requires a signed representation agreement in order to create an attorney-client relationship.


City, State Zip  
Telephone*   ( ) -
Email*   Please leave this field empty.
Marital Status  

Are you considering bankruptcy for any of the following reasons? (select all that apply)

• Pending Foreclosure YesNo
• Pending Repossession YesNo
• Lawsuit or Judgment YesNo
• Wage or Bank Account Garnishment YesNo
• Past Due Child Support YesNo
• Unpaid Income Taxes YesNo
• Medical Bill YesNo
• Credit Card Debt YesNo
• Payday or Finance Company Loans YesNo

What are the sources of household income, including income of spouses? (Select all that apply)
Wages - salary or hourlySelf-EmploymentSocial SecurityRetirementOther

What is your estimated net monthly household income
from all of the above sources? $

Are you required to file tax returns? YesNo

If your answer to the above question was “yes”, please answer the following:
• Are you up-to-date in your tax return filings (both state and federal)? YesNo
• Do you presently owe income taxes for any previous years? YesNo

Feel free to provide any additional information, or submit any questions, in the following field:

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