New Client Form - To save time & money
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Name:
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Phone:
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E-mail:
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How many Dependents?
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Income
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Employed Self-Employed Unemployed
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Monthly Gross Income $:
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Monthly Net "take home" Income $:
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Spouse income (if any) $:
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Filed Bankruptcy before? No Yes
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Lawsuit or summons? No Yes
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Repossession or Foreclosure? No Yes
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Own business? YesNo
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What do you owe money on?
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Credit Card When was last payment?:
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Any recent charges in past 3 months? NoYes
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Medical bill
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Taxesfor what year?:
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Payday loans
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Assets
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Own property - house? NoYes
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Car paid off? Yes No Want to keep? YesNo
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Retirement - 401k, IRA, Pension? YesNo
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Real Estate? NoYes
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Checking balance $:
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Saving balance $:
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During business hours - we will contact you ASAP! Thank you
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