Are you having problems with debt ?
Are you facing foreclosure
or repossession ?
Are collection agencies calling
and threatening ?
Notice:
The Law Office of Grant W. Patten is a federally designated debt relief agency and, among other services, provides legal assistance to people and businesses seeking relief under the United States Bankruptcy Code.
Debts
Assets
Income
Contact Info
Please indicate the approximate amount of your debts.
Credit Cards:
None
Under $5,000
$5,000 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45,000
$45,001 - $50,000
Over $50,000
Medical Bills:
None
Under $5,000
$5,000 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45,000
$45,001 - $50,000
Over $50,000
Student Loans:
None
Under $5,000
$5,000 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45,000
$45,001 - $50,000
Over $50,000
Tax Debts:
None
Under $5,000
$5,000 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45,000
$45,001 - $50,000
Over $50,000
Personal Loans:
None
Under $5,000
$5,000 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45,000
$45,001 - $50,000
Over $50,000
Judgments:
None
Under $5,000
$5,000 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45,000
$45,001 - $50,000
Over $50,000
Pay Day Loans:
None
Under $5,000
$5,000 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45,000
$45,001 - $50,000
Over $50,000
Other (please explain):
Please indicate approximate amounts for each question below.
Real Estate:
Yes
No
Value:
$
Balence:
$
Are You Current On Payment
Yes
No
Motor Vehicle 1:
Yes
No
Value:
$
Balence:
$
Are You Current On Payment
Yes
No
Motor Vehicle 2:
Yes
No
Value:
$
Balence:
$
Are You Current On Payment
Yes
No
Do you have any other assets worth more than $500?
Personal Loans:
Yes
No
Briefly Describe:
Please tell us about your income.
Full-time Employment:
Yes
No
Part-time Employment:
Yes
No
Child Support:
Yes
No
Social Security:
Yes
No
Pension / Retirement:
Yes
No
Unemployment:
Yes
No
Other (please explain):
Approx. Total Monthly Income
$
Please provide us with your contact information.
*First Name:
*Last Name:
*E-mail:
*Phone:
Alternate Phone:
Street Address:
*Zip Code:
(910) 960-7529
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