Bankruptcy Attorney | Florissant MO & St. Charles MO | Teague & Assoc.

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720 North Highway 67 Florissant, Missouri 63031

2536 South Old Highway 94, Suite 222, St. Charles, MO 63303

Book Free Consultation

720 North Highway 67 Florissant, Missouri 63031

2536 South Old Highway 94, Suite 222, St. Charles, MO 63303

Book Free Consultation

Home
About Us
Bankruptcy
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FAQ
Blog
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Contact Us
Testimonials

Bankruptcy Client Intake

Name (Last, First, Middle)

Address

Home Phone Number

Cell Phone Number

Email Address

Internet Access

Yes

No

How did you hear about us?

Referred by

Firm Website

Craigslist

Other (please specify)

Google

Referred by

Other (please specify)

Marital Status

Single

Married

Divorced since

Widowed

Separated since

Divorced since

Separated since

How many children do you financially support?

How many children in your household?

How many people total are living in your household, including yourself?

Have you ever filed bankruptcy before?

No

Yes

(which chapter)

in (which year)

Types of Debts

Credit Cards

Medical Bills

Repossessions

Foreclosure Deficiency

Payday Loans

Bank Accounts

Utilities

Personal Property Taxes

Income Taxes

Other (please specify)

Other (please specify)

Did you file income tax returns for the most recent tax year?

No

Yes

No , because

Yes , and I received a refund of

Where do you live? I am

Renting a home/apartment or living with relatives/friends.

Purchasing a home

If Renting, Rent amount

Owed on home

Value of home

Arrears

Do you own any other real estate?

No

Yes

If yes, please explain

Do you have any motor vehicles with your name on the title even if you are not the one that drives them?

No

Yes

Year

Make/Model

Miles

Value

Amount Owed

Keep?

Year

Make/Model

Miles

Value

Amount Owed

Keep?

Is there anyone you could sue for any reason? (Personal injury, workers comp, etc.)

Yes

No

Do you own a business?

No

Yes

Please explain

Income: Husband's Income

Employment Income

SSI/Retirement/Pension

Other income?

Wife's Income

Employment Income

SSI/Retirement/Pension

Other income?

Thank you for contacting us.
We will get back to you as soon as possible.

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Home
About Us
Bankruptcy
Traffic Violations
FAQ
Blog
Locations
Contact Us
Testimonials

Phone: (636) 244-5277 | Fax: (636) 244-5279

Two Locations to Serve You

Business Hours: Monday - Friday: 9:00 AM - 4:30 PM | Saturday & Sunday: Closed

Phone: (636) 244-5277

Fax: (636) 244-5279

Business Hours:

Monday - Friday: 9:00 AM - 4:30 PM

Saturday & Sunday: Closed

720 North Highway 67 Florissant, Missouri 63031

2536 South Old Highway 94, Suite 222, St. Charles, MO 63303

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