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Free Bankruptcy Consultation Questionnaire

Your submission will be evaluated free of charge and kept strictly confidential.
This form is optional. You can also call us at (617) 716-0282 or email us.

Your Contact Information:
Your First Name:
Your Last Name:
City or Town in Massachusetts where you live:
Phone Number (Best one to reach you at):
Email (*you must submit your email address or the form will not go through):
Your Debts:
How much do you estimate owe on credit cards and store cards?	$
Do you owe any personal loans? If so, please estimate the total.	$
Do you owe any tax debts? If so, please estimate how much.	$
Do you owe any back medical bills? If so, please estimate the total.	$
Do you owe any student loans? If so, please estimate the total.	$
Do you owe any other debts (besides current car loans)? If so, please describe and estimate the total.	$
Have you ever been sued for a debt?	Yes No
Are you being harassed by creditors or collection agencies?	Yes No
Your Property: (Note: If properly represented by an attorney, most people keep all their property in a bankruptcy.)
Do you own a house or condo?	Yes No
Do you own a car or other motor vehicle?	Yes No
Are you behind on any house, car, or other secured debt payments?	Yes No
Your Income and Family:
What is your annual income?	$
Are you married?	Yes No
If you have children, how many are 18 or younger?
Options:
Do you know what type of bankruptcy you would prefer to file?	Chapter 7 Chapter 13 I don't know
Contact:
Tell us a bit about your schedule. What are generally the best times to reach you?
© 2002-, Law Office of Nicholas F. Ortiz, P.C. As defined by federal law, the Law Office of Nicholas F. Ortiz, P.C. is a debt relief agency. We help people file for bankruptcy relief under the Bankruptcy Code. Any information you obtain at this site is not, nor is it intended to be, legal advice or a complete explanation of any topic. Any person making an inquiry to the Law Office of Nicholas F. Ortiz, P.C. through this web site is advised that no attorney-client relationship will be formed without a signed written agreement. Ortiz & O'Donnell is a trade name of Law Office of Nicholas F. Ortiz, P.C.