225 Broadway
Ste. 711
New York, NY 10007
Tel: (212) 843-0050
Fax: (212) 571-0640
Efax: (212) 202-7681
(718) 302-4000


(By Appointment Only)
Long Island Location
1225 Franklin Avenue
Ste. 325
Garden City, NY 11530
Tel: (516) 222-0070

(By Appointment Only)
Midtown Location
Penn Station
7 Penn Plaza
Ste. 830
New York, NY 10001






E-mail us at
info@sbkass.com

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1) INFORMATION:

First Name:
Last Name:
Address:
City:
State:
Zip Code:
E-Mail: (required)
Business Phone:
Home Phone:
Cell Phone:

2) NATURE OF FINANCIAL DIFFICULTY:

3) TYPE OF LEGAL SERVICES SOUGHT:

Bankruptcy Case:
Chapter 7
Chapter 13
Chapter 11
Negotiation With Creditor(s)
I.R.S. Representation
Other Specify:

4) DEBTS:

Type of Debt Amount # of
Creditors		 Status
Credit Cards
Medical Bills
Car Loan/Car Lease
Mortgage
Taxes
Other:

5) ASSETS:

Type of Asset Description Fair
Market
Value		 Ownership
and/or Liens
House (Appraisal)
Car (Name, Model, Mileage)
Bank Account
Liquidation Value of Furniture
Investments
Retirement Account
Other Property Having Value

6) INCOME / EXPENSES MONTHLY:

Average Monthly Net Income
Average Monthly Expenses

7) MORE INFORMATION REGARDING TYPE OF DEBT:

A) Mortgage Arrears:

Amount

# Month

Monthly payment

B) Credit Cards: Yes No
Any Joint Holder?
Able to Pay at Time?
Any Cash Advances?
Any Luxury Items?
         
 
C) Taxes: Yes No  
Is it an Income Tax?
Is Tax Over Three Years Old?
Has Taxing Authority Assessed Within 240 Days?
Any Liens?
 

 

 

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