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Contact Eric N. Klein & Associates, P.A.

Office Locations

4800 N. Federal Highway
Building B, Suite 307
Boca Raton, FL 33431
561-353-2800

4440 PGA Boulevard
Suite 600
Palm Beach Gardens, FL 33410
561-353-2800

Boca Raton Bankruptcy Attorneys, Eric N. Klein & Associates, P.A.

© Copyright 2004-2009 Eric N. Klein & Associates, P.A. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation.

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The attorneys at Eric N. Klein & Associates have the legal experience to help you with your divorce case. Click here to learn more about our South Florida divorce lawyers.

Let us help you! Complete the form below regarding your financial status and we will contact you after reviewing it. All information you provide is strictly confidential and will be deleted within 30 days.*

Personal Info

First Name:

(required)

Last Name:

(required)

Email:

(required)

Address:

Apt/Floor:

City:

State: Zip:

Telephone:

(required)

Please specify day/time for a return call: (required)

Bills

What type of bills do you have? Please check all that apply:

Credit Cards

Tax Debts

Medical Bills

Government Fines

(parking tickets, moving violations, suspensions)

Judgments

Student Loans

Personal Loans

Total Number of Bills:

Total Amount:

Under $5,000

$10,000-$15,000

$15,000-$20,000

$20,000-$30,000

$40,000-$50,000

Over $50,000

Additional Info:

Property

Home:

Approximate value of home: $

Balance on mortgage: $

Monthly mortgage payment: $

Are you up to date on your mortgage payments? Yes No

Are there any other mortgages on this property? Yes Yes

Vehicles:

Vehicle 1:

Year: Make:

Model:

Value: $

Balance: $

Monthly payment: $

Are your payments up-to-date?

Yes No

Vehicle 2 (optional):

Year: Make:

Model:

Value: $

Balance: $

Monthly payment: $

Are your payments up-to-date?

Yes No

Other:

Please list any other significant property:

Income

You:

How often do you get paid?

Every week

Every 2 weeks

Twice a month

Monthly

Net pay: $

(after taxes, medical & other deductions)

Spouse:

How often do you get paid?

Every week

Every 2 weeks

Twice a month

Monthly

Net pay: $

(after taxes, medical & other deductions)

Other Income:

What other types of income do you have? Please check all that apply:

(parking tickets, moving
violations, suspensions)

Are your payments
up-to-date?

Are your payments
up-to-date?