Bankruptcy Evaluation Fill out the information below and submit to C.E. Craig & Associates Inc. A licensed professional will review your information and contact you within one business day to discuss your options. Your information is confidential and we do not use it for any other purpose other than to help you evaluate your options. Please let us know If you would prefer a FREE in-person consultation Average Monthly Family Income Number of People in Your Household* 12345678910 Your Average Monthly "Take Home" Pay* $0-$1000$1000-$2200$2201-$3500over $3500 Other Family Members Average Monthly Take Home Income $0-$1000$1000-$2200$2201-$3500over $3500 Non Discretionary Monthly Expenses Child Care Costs (including child Support/spousal support) Out of Pocket Medical Costs (perscriptons, MSP etc.) List of Personal Assets Personal Residence - Tax Assessed Value Other Personal Assets Vehicle 1 noneless than $5000$5000 to $10,000$10,000 to $15,000over $15,000 Vehicle 2 noneless than $5000$5000 to $10,000$10,000 to $15,000over $15,000 Recreation Vehicle noneless than $5000$5000 to $10,000$10,000 to $15,000over $15,000 List of Debts/Creditors Credit Cards noneless than $3000$3000 to $5000$5000 to $10,000$10,000 to $20,000$20,000 to $40,000$40,000 to $60,000over $60,000 Line of Credit noneless than $3000$3000 to $5000$5000 to $10,000$10,000 to $20,000$20,000 to $40,000$40,000 to $60,000over $60,000 Overdraft noneless than $3000$3000 to $5000$5000 to $10,000$10,000 to $20,000$20,000 to $40,000$40,000 to $60,000over $60,000 Mortgage - Personal Residence Other Debts including Tax Debt Loan - Vehicle 1 Loan - Vehicle 2 Loan - Recreation Vehicle Contact Information Your Name (Required) Your Phone Number(Required) Your Email Address(Required) How do you prefer we contact you?* EmailPhone Would you like to request a free in-person consultation? YesNo