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BANKRUPTCY QUESTIONNAIRE |
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Print out this form. Fill out and bring with you when you come to our office. Please fill out as much information as you can so we can better help you. Information given remains strictly confidential. NOTE: WE ARE ABLE TO PROVIDE INFORMATION ONLY WITH REGARD TO STATE OF TEXAS BANKRUPTCY. IF YOU DO NOT LIVE IN TEXAS, DO NOT FILL OUT THIS FORM. |
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| First Name | Last Name |
| Address | City |
| State | Zip |
| Home Telephone | Work Telephone |
| Cell Phone | Pager |
| Primary E-Mail | Secondary E-Mail |
| How did you learn about us? | |
| How long have you lived at your current address? | |
| If you have
lived at your current address for less than two years, what was your previous address? |
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| Previous address | City |
| State | Zip |
| How many children or dependents (people who you support?) | |