zconsultation Haines Consultation Original Phone Consultation Date(Required) MM slash DD slash YYYY Appointment Scheduled For Date MM slash DD slash YYYY Other Assets / Additional Notes (This will get copied into calendar event and into Best Case as the client notes)Filing Solo or Joing?(Required) Solo Joint Primary Debtor Marital Status(Required) Single Married Legally Separated Separate Households Separate Households for BK Purposes Divorced Primary Debtor DetailsPrimary Debtor Name(Required) First Last Primary Debtor Age Primary Debtor PhonePrimary Debtor Email(Required) Number of DependentsChoose One0123456+Dependents Notes Husband IncomeWife IncomeHusband & Wife Income SourcesHusband Employment: $ Business: $ Social Security: $ Pension: $ VA Disability: $ Unemployment: $ Support: $ Other: $ Wife Employment: $ Business: $ Social Security: $ Pension: $ VA Disability: $ Unemployment: $ Support: $ Other: $Child Support(Required) No Yes - Paid Yes - Received Monthly Child Support Amount Co-Debtor DetailsCo-Debtor / Spouse Name First Last Co-Debtor Age Co-Debtor Email Address (Put Email in "other" field)(Required) Filing Solo - Not Needed Not available - Danielle will need to get Other Secondary Debtor PhoneDebtTypes of Debt(Required) Credit Card Medical Vehicle Repo Personal Loans Student Loans IRS Other? Select AllDebt DetailsCredit Card: $ Medical: $ Vehicle Repo: $ Personal Loans: $ Student Loans: $ IRS: $ Other: $Mortgage?(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 mortgageVehiclesVehicles (Year Make Model Mileage)Car 1 - Value: Owned?: Monthly: Car 2 - Value: Owned?: Monthly: Car 3 - Value: Owned?: Monthly: Being Sued? Yes No Being Sued Notes Wages Being Garnished? Yes No Garnished Notes Prior Bankruptcy? (Last 10 Years) Yes No Other Prior Bankruptcy Notes Recent Charges--------Last 30 Day-------- --------Last 90 Days--------Send Follow-up Thank You Email to Prospect? Yes No Custom Notes To Be Included in Thank You EmailProspect Status Retained Thinking Rejected Retainer Fee Rejected Reason Retained Summary To Paste Into Best Case(Required)Prospect Thinking About it Notes (Goes into Calendar Event Description)(Required) 48746Δ
