schwartzbankruptcy.com

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SCHWARTZ BANKRUPTCY
THREE CONVENIENT LOCATIONS
TO SERVE YOU

Louisville, KY
3339 Taylorsville Rd
Louisville, KY 40205
(502) 485-9200

Louisville, KY
8508 Preston Highway
Louisville, KY 40219
(502) 485-9200

New Albany, IN
810 East Market Street
New Albany, IN 47150
(812) 945-9200

Kruger & Schwartz
Schwartz Bankruptcy

3339 Taylorsville Road
Louisville, KY 40205
Phone: (502)485-9200
Fax:(502)485-9220

Office Hours:
8:30 a.m. - 5:30 p.m.

AFTER HOURS CALL
(502)693-5151

Call Today - Free Consultation!
1(866)366-3328

Email Us Now!

EVENING & WEEKEND APPOINTMENTS AVAILABLE

BANKRUPTCY PRE-QUALIFICATION

This form is completely CONFIDENTIAL.

Please complete all data requested in the form below.
If not applicable, enter N/A

General Information

Date:
Name:
Spouse's Name:
Address:
City:
State:
Zip:
Phone Number:
E-mail Address:
Number of Miner Children at Home:
Total gross Annual Household Income (per you last tax return):
Self Employed:	Yes No

Assets That You Own

Do you own Real Estate?	Yes No
Value of your Real Estate:
1st Mortgage Balance:
1st Mortgage Payment:
Arrearage?:

2nd Mortgage Balance:
Monthly Payment:
Arrearage:

Auto Owned?	Yes No
Year/Make/Model:
Date of Purchase:
Auto Value:
Amount Owed:

Debts

Aside from home mortgages and car loans,
do you owe any of the following?
If YES, state the amount owed.
If you do not know the exact amount owed,
estimate the amount owed.

Total Amount of Credit Card Debt:
Total Amount of Medical Debt:
Student Loan Debt:
Signature Loan Debt:
Other (Please specify):
Other Amount:

Taxes

Amount of your Last Tax Refund:
Taxes Owed?	Yes No
Amount:
What year?

Income

Your Income:
Gross Pay:
Net Pay:
How often do you get paid?	Weekly Bi-Weekly Monthly Yearly
Spouse Income:
Gross Pay:
Net Pay:
How often does your Spouse get paid?	Weekly Bi-weekly Monthly Yearly

Monthly Living Expenses

Rent or Mortgage Payment:
Gas and Electric:
Water & Sewage:
Medical Expenses:
Auto Insurance:
Home Owners Insurance (if not escrowed):
Property Taxes (if not escrowed):
Auto Payment(s):
Gas for Autos:
Alimony or Child Support:
Groceries:
Child Care Expenses:
Cable TV/Satellite:
Other Expenses not Listed Above:
Total Monthly Expenses:

This website form is designed for general information only.
The information presented on this form should not be construed to be the formation of a lawyer/client relationship.

Call Now for a Free Consultation
KY:(502) 485-9200
IN:(812) 945-9200

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