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287 Marschall Road, Ste 203-A Shakopee, Minnesota 55379 Phone: (952) 448-3333 Fax: (952) 469-1728

Initial Online Interview:

Because we want to give you as much detailed advice as possible, we need to collect some information about you and your financial situation up front. Please fill out the forms over the next few pages. It should take between 5 and 10 minutes to go through the entire form. Having this information in advance will allow us to provide you with a significant amount of detail and advice on what avenue you should take to deal with your financial situation.

* indicates a required field

Your Contact and Household Information:

First Name*

Last Name*

Email *

Phone *

Does your spouse maintain a separate household?



Spouse First Name

Spouse Last Name

Marital Status

Number of People in your Household?

Some of this information may appear duplicative. That is just the nature of the form. All of your information is treated with confidentiality. We know how difficult it is to address financial issues. When you provide us with your information, we will treat it as if it were provided under the attorney/client privilege and it will never be released to any third party.

Employment Information:

I am unemployed at this time

If you receive unemployment how much do you receive weekly?


My spouse is unemployed at this time

If your spouse is receiving unemployment how much do they receive weekly?

We need your employment information to create an accurate picture of your income amount. Income amount and household size contribute to a means test to help determine which Chapter of bankruptcy will work best for you. .

Your Employer
Employer Name

Hourly Wage

Hours per Week

Monthly Gross Earnings

- Less Taxes

- Less Insurance

- Less Other Deductions

=Monthly Net Earnings


Spouse Employer
Employer Name

Hourly Wage

Hours per Week

Monthly Gross Earnings

- Less Taxes

- Less Insurance

- Less Other Deductions

=Monthly Net Earnings