Initial Meeting Questionnaire

1
What is your Name* This field is required.
First Name
Last Name
2
What is your Phone Number? * This field is required.
Please enter a valid phone number.
3
What is your email address?* This field is required.
example@example.com
4
Schedule your Initial Meeting with Peterson Zeyer Law then continue to the Initial Meeting Questionnaire.* This field is required.Once your meeting is scheduled continue to the Initial Meeting Questionnaire. The Initial Meeting Questionnaire MUST be completed and submitted before attending the Initial Meeting Questionnaire.
5
Have you filed Bankruptcy before?* This field is required.Answer YES even if it was very long ago.
YESNO
6
What year did you most recently file Bankruptcy?* This field is required.You don't need the exact date but the year you filed will be helpful.
7
What bankruptcy chapter did you most recently file?* This field is required.Common chapters are Chapter 7 and Chapter 13.
8
Have you lived in Idaho over 3 consecutive years? * This field is required.
YESNO
9
What date did you move to Idaho?* This field is required.Enter the Month, Day, and Year you moved to Idaho.
10
What State did you move from?* This field is required.
11
Are you currently employed?* This field is required.
YESNO
12
What is your hourly rate of pay? * This field is required.Enter how much you make an hour.
Example: $18
13
How many hours per week do you work?* This field is required.Select all that apply to you.
Less than 40 hrs a week
40 hrs only
40 hrs plus over time
100% Commission
I also receive: tips, per diem, bonus income, other income from my employer.
Other
14
Are you Married?* This field is required.Answer YES if your are legally married but physically separated.
YESNO
15
What is your Spouse's Name?* This field is required.
First Name
Last Name
16
What is your Spouse's email address?* This field is required.
example@example.com
17
What is your Spouse's Phone number?* This field is required.
Please enter a valid phone number.
18
Is your Spouse employed* This field is required.
YESNO
19
What is your Spouse's hourly rate of pay?* This field is required.
Enter a dollar per hour amount
20
How many hours per week does your Spouse work?* This field is required.Select all that apply to you.
Less than 40 hrs a week
40 hrs only
40 hrs plus over time
100% Commission
I also receive: per diem, bonus income, other income from my employer.
21
Do you have any additional sources of regular monthly income?* This field is required.This could be from Child Support, driving Uber on the weekend, any other side gig or job.
YESNO
22
How much monthly income do you receive from these additional sources of income?* This field is required.Add up all the income from all other sources and list the total additional income below.
23
Do you have any children or dependents at home? * This field is required.Select YES if you have an adult dependent or minor dependents 18 years old or younger.
YESNO
24
How many children/dependents are in your home?* This field is required.
25
What is your mailing address?* This field is required.Enter the address where you get your mail.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
26
Do rent your Home/Apartment? * This field is required.
YESNO
27
Are you buying any land, buildings, or houses?* This field is required.Answer YES if you have a home and are paying a mortgage. Answer YES if you have bare land.
YESNO
28
What is the current market value of your land, building, or house?* This field is required.Check with Zillow, Trulia, Redfin, Realtor.com for help
Enter a dollar amount
29
Do you have a first mortgage on your land, building or house?* This field is required.Answer YES if you have a traditional mortgage, reverse mortgage, or Owner/Carry Loan.
YESNO
30
What is the total balance due on your first mortgage?* This field is required.
Type a dollar amount.
31
Are you behind on your first mortgage payment?* This field is required.
YESNO
32
Do you have a SECOND mortgage or LINE OF CREDIT on your land, building or house?* This field is required.
YESNO
33
What is the total balance due on your SECOND mortgage or LINE OF CREDIT?* This field is required.
34
Are you behind on your payment for your SECOND mortgage or LINE OF CREDIT?* This field is required.
YESNO
35
Is your real estate in Foreclosure?* This field is required.
YESNO
36
If your real estate is in Foreclosure, what is the foreclosure date?* This field is required.Enter the foreclosure date below.
37
Home Equity Calculation
38
Do you expect to inherit any land, buildings or houses from a family member that has recently passed away?* This field is required.
YESNO
39
Do you have any Investment Accounts, Investment Apps, or Crypto Currency?* This field is required.
YESNO
40
Have you owned or operated a business in the last 8 years? * This field is required.Answer YES if you have an LLC or just operated a business as a sole proprietor.
YESNO
41
Is your business still operating?* This field is required.Answer YES if you are still receiving income from your business.
YESNO
42
Does your business own any assets? * This field is required.Business assets could include: bank accounts, vehicles, tools, supplies, customer lists, etc.
YESNO
43
Do you have any retirements accounts?* This field is required.IRA, 401K, PERSI, etc.
YESNO
44
Do you own or are you purchasing a vehicle?* This field is required.Answer YES if you own a vehicle outright, if your paying a car payment, and if you co-signed for someone else?
YESNO
45
What is the current value of this FIRST vehicle?* This field is required.Check NADA or Kelly Blue Book
You will not be required to sell this vehicle. Enter the dollar amount you could sell the vehicle for on Facebook Marketplace.
46
How much do you owe on this FIRST vehicle?* This field is required.Enter $0 if you do not have an auto loan or title loan on this vehicle.
47
FIRST Vehicle Equity Calculation
48
Do you own or are you purchasing a SECOND vehicle?* This field is required.Do you own a vehicle outright? Are your paying a car payment?
YESNO
49
What is the current value of this SECOND vehicle?* This field is required.Check NADA or Kelly Blue Book
50
How much do you owe on this SECOND vehicle?* This field is required.Enter $0 if you do not have an auto loan or title loan on this vehicle.
51
SECOND Vehicle Equity Calculation
52
Do you own or are you purchasing a THIRD vehicle?* This field is required.Answer YES if you own a camper, motorcycle, boat, or any other type of vehicle.
YESNO
53
What is the current value of this THIRD vehicle?* This field is required.Check NADA or Kelly Blue Book
54
How much do you owe on this THIRD vehicle?* This field is required.Enter $0 if you do not have an auto loan or title loan on this vehicle.
55
THIRD Vehicle Equity Calculation
56
Do you have other vehicles not mentioned above?* This field is required.Select YES if you have ATVs, boats, trailers, etc. not valued previously.
YESNO
57
What other any other type vehicles do you have?* This field is required.Check all the different types of vehicles you own or that you have in your possession.
No other vehicles
Motorcycle
Dirtbike
ATV
UTV
Boat & Trailer
Camper
RV
Trailer: flat-deck, dump, etc.
Tractor
Other
58
Are you currently being sued?* This field is required.Have you been served as summons and complaint?
YESNO
59
Are your wages currently being garnished?* This field is required.Answer YES if wages are currently being taken out of your pay checks.
YESNO
60
Do you owe the IRS or the State any tax debt?* This field is required.
YESNO
61
Have you filed every tax return you are required to file?* This field is required.Have you missed filing any tax returns over the years?
YESNO
62
What type of Unsecured Debt do you have?* This field is required.Unsecured debts are debts that are not attached to collateral. Click all that apply.
Credit Cards
Consolidation / Bank Loans
Medical Bills
Student Loans
Personal Loans
Bank Overdraft Fees
Utilities
Auto Loan Due to Repo
Payday / Online Loans
Other
63
How much Unsecured Debt do you owe?* This field is required.Add up all your medical bills, credit card bills, and payday loans and estimate a total amount you owe?
Do not count car loans, mortgage loans or student loans.
64
What concerns you most about the bankruptcy process?* This field is required.We work hard to make sure you have all the information and education you need about the bankruptcy process. Let us know what concerns you most and we will make sure to address it.
Huge
Large
Normal
Small
Ok
Ok
65
I promise the answers I provided in this questionnaire are True and Correct. I request that Peterson Zeyer Law use this information ONLY to evaluate my bankruptcy options.* This field is required.
YESNO
Should be Empty: