Atlanta GA Bankruptcy Attorney Chapter 7, Chapter 13, Foreclosure

New Client Online Form

First Name: Middle:
Last Name:
Your Social Security Number:
Address:
City: State: Zip:

Mailing Address(if different):
City: State: Zip:

County of Residence:
Email:
Home Phone: Cell:
Work Phone: Other:
Marital Status:

*If you are married and not separated,* we need your spouse’s info as well**
First Name: Middle:
Last Name:
Spouse's Social Security Number:
Cell: Work Phone:

Reason for visit:


Are you a current client?: Case Number:
Is the above address new?

If you are NOT an existing client:
HAVE YOU OR YOUR SPOUSE EVER FILED FOR BANKRUPTCY?

LIST YOUR MONTHLY GROSS INCOME BEFORE DEDUCTIONS:
	You	Spouse
WAGES
SELF EMPLOYMENT
RETIREMENT/ SS
OTHER

Would you like us to pull your credit report for $20 per person?

� 2003-2008 Clark & Washington, P.C.
3300 Northeast Expressway Bldg. 3 Atlanta, GA 30341
We are a debt relief agency. We help people file for bankruptcy relief under the Bankruptcy Code.

Disclaimer: This Website contains general information about various areas of bankruptcy.
It is highly recommended that persons with debtor/creditor problems seek the advice of an
attorney. The information on this Website is not intended to be legal advice and viewers
should consult with an attorney.

DHTML Menu By Milonic JavaScript