| Current Situation |
| What
is motivating you right now to
take action and resolve your present financial predicament? |
| (please
check all
that apply) |
|
I’m
on the verge
of filing bankruptcy, however I would first
like to
attempt a
voluntary workout plan with
my
creditors with the limited funds that I
have
available.
|
|
I’ve
tried consumer credit counseling and
it’s not solving my
problem. |
|
I
want to re-finance my mortgage or apply for a home loan, but I first
need to
settle some old debts before
my loan can be funded. |
|
I’ve
had lingering past due debts for an extended period of time, but now I
have
some money to work with and I would just like to get these matters
resolved
once and for all because I know they’re not going to
magically disappear. |
|
I
am
sick and tired of the bill collectors calling constantly. |
|
I’m
being threatened
with a lawsuit by one
or more of
my creditors. |
| |
Other:
Please explain below. |
|
|
| How
many different matters (i.e. accounts) need to be resolved? |
|
*required
|
| What is
the grand total
(approximately) of all your unsecured debts? |
|
*required
|
| How
far past due are your accounts? |
|
0-3
Months |
|
3-6
Months |
|
6-12
Months |
|
more
than 12 Months |
|
None
of my accounts are past due. |
| Please
describe the
event(s) that caused your present financial
hardship: |
|
| Have you
considered filing
bankruptcy? |
|
Yes |
| |
No |
| If
yes, what is the reason that you haven't
filed? |
|
| What
additional concerns
(if any) do you still have? |
|
| Current Situation |
| Assuming
your creditors
would agree to settle your outstanding debts
for $0.50 on the dollar or less, are you able to secure sufficient
funds to honor such settlements? |
|
Yes |
|
Definitely. |
|
No |
|
That
would be totally Impossible. |
|
Probably |
| Strategy
for Securing
Funds |
| (please
check all
that apply) |
|
I
am able to re-finance my mortgage or get a home equity loan.
|
|
A
friend or family member is able to loan me the money (then I will make arrangements to pay them back privately). |
| |
I
would be willing to liquidate (or take a loan against) my retirement
account. |
| |
I
have property that I could sell to raise the necesary funds (i.e. car,
boat, rea estate, stamp collection, etc.). |
|
I
would set aside a certain amount of money each month and accumulate
funds to settle my debts, one by one, as funds
became available. |
|
What
amount per month? |
| |
Other:
Please explain below. |
|
|
| Time
Frame for Securing
Funds |
|
0-6
Months |
|
6-12
Months |
|
12-24
Months |
|
24-36
Months |
|
Funds
are available right now. |
| Contact Information |
| First
Name |
|
*required
|
| Last
Name |
|
*required
|
| Email
|
| *required
|
| Phone
|
| *required
|
| State
|
| *required
|
| Please
enter the Security Code shown below: |
 |
|
|
