zconsultation Haines Consultation Haines Consultation Original Phone Consultation Date(Required) MM slash DD slash YYYY Appointment Scheduled For Date MM slash DD slash YYYY Filing Solo or Joing?(Required) Solo Joint Primary Debtor Marital Status(Required) Single Married Other Primary Debtor Name(Required) First Last Co-Debtor / Spouse Name First Last PhonePrimary Debtor Email(Required) Co-Debtor Email Address (Put in Other area)(Required) Filing Solo - Not Needed Not available - Danielle will need to get Other Husband IncomeWife IncomeNumber of Children123456+Child Support(Required) No Yes - Paid Yes - Received Monthly Child Support Amount DebtTypes of Debt(Required) Credit Card Medical Vehicle Repo Personal Loands Student Loans Other? Select AllMortgage?(Required) Yes No Is mortgage current? Yes No Mortgage Amount OwedProperty FMVMonthly Mortgage PaymentMonths Behind on mortgageProperty Sale Date Set For (Or put N/A) 2nd Mortgage?(Required) Yes No 2nd Mortgage Amount Owed2nd Monthly Mortgage PaymentIs 2nd mortgage current? Yes No Months Behind on 2nd mortgageVehiclesCar 1 ValueCar 1 OwedCar 1 Monthly PaymentCar 2 ValueCar 2 OwedCar 2 Monthly PaymentCar 3 ValueCar 3 OwedCar 3 Monthly PaymentPrior Bankruptcy? Yes No Other Additional Notes / Other Assets?Send Follow-up Thank You Email to Prospect? Yes No Custom Notes To Be Included in Thank You Email 93523Δ
