Request for Advice

Free Consultation of Financial Situation For Residents of Oregon.

Please provide us with as much information as possible by submitting the form below. If you prefer, you can print this form, then fill it out, and fax it to us at (503) 213-6122. Or, you may mail it to Kenneth R. Tolliver, 10200 SW Katherine Street, Tigard, OR 97223.

1) Contact Information:

First Name
Last Name
Address
City
State
Zip Code
E-Mail
Home Phone
Work Phone

 

2) Nature of Financial Difficulty:

 

3) Services Sought:

Free Consultation
Possible Legal Representation
Possible Legal Form Preparation
Don't Know

 

4) Type of Legal Services Sought:

Bankruptcy Case:
Chapter 7

Don't know what Chapter I need?
Chapter 13
Chapter 11
Negotiation With Creditor(s)
Litigation With Creditor(s)
Other Specify:
Don't Know

 

5) Debts - Please give approximate amounts, # of creditors, and status
(current or # of months arrears) for each category:
TYPE OF DEBT $AMOUNT$ # OF
CREDITORS		 STATUS*
Credit Cards
Personal Loans/Credit Line
Medical Bills
Car Loan/Car Lease
Mortgage
Taxes
Business Related
Other:
* (Whether you are Current or if you are behind in payments the Amount of Arrears)

 

6) Assets - Please give description and approximate fair market value of each:

TYPE OF ASSET DESCRIPTION FAIR
MARKET
VALUE		 OWNERSHIP*
AND/OR LIENS**
House
Any Other Real Property?
Car
Cash
Bank Account
Business
Law Suit Against Someone Else
Investments
Retirement Account
Other Property Having Value
* i.e., sole owner, own with spouse, jointly own with others
** Any loans with item as collateral

 

7) Income vs. Expenses:

Average Monthly Net Income
Average Monthly Expenses

 

8) More Information Regarding Type of Debt:

CREDIT CARDS (if applicable)
Who is Liable?
Last Time Used
Last Time Paid
Able to Pay at Time of Use?
Any Cash Advances?
Any Luxury Items?
Rate of Use (steady or any
sharply higher or lower use)
MORTGAGE ARREARS (if applicable)
Situation
Number of Months in Mortgage Arrears
Amount of Monthly Mortgage Payment
Are the Following Being Escrowed by Bank?
Yes No Yearly Amount
Taxes
Insurance
Currently Able to Pay Monthly
Mortgage Payment? (without
taking into account the arrears)
Goal: To save house by catching up on mortgage arrears
Can not catch up and seek to prevent possible deficiency judgment
Other
Not sure
Cause for Arrears
Who is Liable on the Mortgage?
Who Owns the Home/Real Property
and Who is Living There?

 

9) How Did You Hear About Us?

Internet Site, Specify
Internet Search, Specify
Advertisement, Specify
Current Client, Specify
Other Referral, Specify

 

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Copyright © 2000 Kenneth R. Tolliver Attorney at Law
Revised: March 30, 2001.