Bankruptcy Contact Form

Mounting bills can put stress on any family’s budget, but when there isn’t enough income coming in to pay off those debts, late bill payments are inevitable. If you find yourself facing insurmountable debt and bankruptcy appears to be your only option, contact an experienced bankruptcy attorney to discuss your options.

The Berkley Bankruptcy Attorneys represents clients in Phoenix and Maricopa County with consumer and small business bankruptcies.

If you are considering a Chapter 7 or Chapter 13 filing, contact attorney Martin J. Berkley today. You can reach us by toll-free phone or e-mail. Call 1-877-725-8507.

Thank you for contacting Berkley Law Office. Your message has been sent.

Call us now

or use the form below.

Bankruptcy Contact Form

Name

Email Address

Phone Number

Do you intend to file a joint bankruptcy petition with your spouse?
Yes No 

If yes, include information for both you and your spouse below.

Name(s), including middle initial.

Residence address, including county.

How long have you been at this address?

Other addresses in the last ten years.

Address How Long?

Other telephone number(s)

Work

Cell

Other

Have you used any other name(s) in the last six years?
Yes No 

If yes, please list here

Single Separated Married Divorced 

If married, how long?

If divorced, how long?

Ages of minor children living with you

Age(s), and amount(s) of child support paid:

Age Amount

$

$

$

$

Is any child support past due?
Yes No 

Amount
$

Husband's employment (name and addr.):

How long at this job?

Occupation

Income paid
weekly semi-monthly monthly other 

Gross

Net

Wife's employment (name and addr.):

How long at this job?

Occupation

Income paid
weekly semi-monthly monthly other 

Gross

Net

Income from other sources (second job, investments, social security, child support, workers' compensation etc.) State source and amount.

Do you owe any money to the Internal Revenue Service? (IRS)
Yes  No 

If yes, for what year(s)?

How much?
$

Do you have any unpaid student loans?
Yes  No 

Amount
$

Monthly Expenses

Rent
Real Estate Taxes
Electric
Home Maintenance
Gas
Life Insurance
Water
Health Insurance
Phone
Auto Insurance
Cable
Homeowner/Rent Ins.
Trash
House Payment

Do you pay anyone spousal support (alimony)?
Yes No 

If yes, to whom and how much?

Do you own or are you purchasing a home or other real estate?
Yes No 

Tax assessed value
$

First Mortgage Loan balance
$

Loan current?

Amount Behind
$

2nd Mortgage Loan balance
$

Loan current?

Amount Behind
$

3rd Mortgage Loan balance
$

Loan current?

Amount Behind
$

Are you facing foreclosure?
Yes No 

Foreclosure date

List any liens against your property.

List all vehicle loans, including vehicle type (car, truck, motorcycle etc.)

Vehicle  
Est. loan balance $
Loan current  
Amount behind $
     
Vehicle  
Est. loan balance $
Loan current  
Amount behind $
     
Vehicle  
Est. loan balance $
Loan current  
Amount behind $

List all vehicles you own outright (no loan balance).

Vehicle Est. value
$
$

Have you purchased any secured items (electronics, boats, jet skis®, appliances, etc.) in the last two years on which you still owe money?
Yes No 

Have you taken out a loan from a finance company, credit union, bank, or any other source, and secured the loan by household items or other types of secured collateral?
Yes No 

Creditors' names

Estimate balances owed on all other types of debt listed below

$  Medical bills
$  NSF checks
$  Credit cards
$  Misc. bills

When was the last time you used any of your credit cards? (approx. date)

How much has total owed on cards increased in the last 12 months?

Have you had any new cards issued in the last 12 months?

Do you anticipate receiving a tax refund?
Yes No 

How much?
$

Are you eligible for the Earned Income Credit (EIC)?
Yes No 

How much?
$

List all judgments, lawsuits, liens, and garnishments against you.

Special concerns

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