Michael J. Halprin & Associates Attorney And Counselor At Law Serving Philadelphia and the Surrounding Area
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If you'd like the Law Offices of Michael J. Halprin & Associates to contact you regarding an injury you've suffered, please fill out this preliminary form.

Your Name:
Your Phone Number:
Your Email Address:
What is your monthly income?
Have you filed for bankruptcy before? Yes No
If yes, how many times?
What type of debt do you have that's leading you to investigate bankruptcy?
If other, please specify:
Credit Card Information
How much credit card debt do you have?
Over what period of time did you incur the debt?
How much credit card debt did you have 6 months ago?
How much credit card debt did you have a year ago?
What is teh most you have charged on a single card in the last six months?
Did you charge more than $1000 on a single card in the last 6 months? Yes No
Are you current on your credit card payments? Yes No
How much are you paying per month on your credit cards?
When did you last use your credit cards?
How much did you charge?
What was it for?
When did you last make a credit card payment?
Other unsecured debt (where the creditor does not have collateral):
First Mortgage/Property Information Information
If you own real estate, is it your residence? Yes No
Do you own it:
If someone else, please specify:
If you tried to sell the property how much could you get for it?
What do you base that number on? (Make sure basis is reasonable)
Has anyone on the block sold their property in the last two years? Yes No
If YES, how much did they sell it for?
Do you have any: Mortgages
Home equity loans
Real estate tax liens
Water/sewer liens
Tax assessment
Judgement liens
Other property liens
If so, specify the creditor's name and amount:
Second Mortgage/Property Information Information
If you own real estate, is it your residence? Yes No
Do you own it:
If someone else, please specify:
If you tried to sell the property how much could you get for it?
What do you base that number on? (Make sure basis is reasonable)
Has anyone on the block sold their property in the last two years? Yes No
If YES, how much did they sell it for?
Do you have any: Mortgages
Home equity loans
Real estate tax liens
Water/sewer liens
Tax assessment
Judgement liens
Other property liens
If so, specify the creditor's name and amount:
Vehicle Information
How many vehicles do you own? One More Than One
For the Primary Vehicle
Do you own the vehicle:
Do you want to keep the car? Yes No
Are you current on the vehicle payments? Yes No
What is your car worth?
What is the balance owed?
 

DISCLAIMER: Filling out this form does not constitute an attorney-client relationship, nor does it ensure that the Law Offices of Michael J. Halprin & Associates will contact you regarding the information you provide.



Featured Practice Areas:
Chapter 7 Bankruptcy Chapter 13 Bankruptcy Bankruptcy Information Predatory Lending Personal Injury Medical Malpractice



Dedicated Professional Honest

We Put Your Interest First! Call us for a free initial consultation 215-389-6913
Bankruptcy Information Center:
Bankruptcy reform has been a hot topic for Congress since 1994 when legislation was introduced... more ...

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