Strouse Law Firm – Client Questionnaire Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Name/Phone of Nearest Friend/Relative Not Living With YouHow did you hear about Strouse Law ? *Have you ever filed a bankruptcy before?Chapter/Date Filed, if knownAre you a small business owner/operator?YesNoMarital StatusSingleMarried , Live TogetherMarried , Live ApartDivorcedSpouse NameSpouse Address if different from yoursCityStateZip CodeYour Home AddressCityStateZip CodeRent or Own RentOwnIf you own, what is the approximate value of your home?Date of Purchase / Purchase Price :Home Mortgage Lender / Amount OwedMonthly Mortgage PaymentBehind? If so, how many monthsSecond Mortgage Lender / Amount OwedMonthly HELOC or Second Mortgage Payment amountBehind? If so, how many months?Property Tax AmountEscrowed into mortgage payment or no?YesNoHO InsuranceDo you own other real estate (timeshares, rental prop, vacation home)YesNoMonthly Health Insurance ExpenseMonthly Childcare ExpensesDo you expect any change in income during the next year? If so, please explain ::Type of Car (Year Make Model)Vehicle 1 Lender / Amount OwedVehicle 1 Monthly Payment AmountVehicle 2 Lender / Amount OwedVehicle 2 Monthly Payment Amount.Do you have any other motor vehicles?YesNoDo you have a claim or lawsuit against anyone? What might you receive, if you win?Do you owe any money to the IRS or the State of Wisconsin?Please list all past due bills to best of your ability (ex.credit cards, medical, loans)Do you have student loans and if so, amount(s) owed?Are the student loansFederalPrivateEmployer/Job DescriptionGross Pay (before deductions) per monthSpouse Employer / Job DescriptionSpouse Gross Pay per month (before deductions)Other Monthly IncomeYesNoSource / AmountPlease list ages/relationships of all dependents you supportComment or Message *CommentSubmit
