Initial Debt Management Questionnaire

Bold labels and indicate required information.

Preliminary Debt Management Questionnaire*

Renting Home

Purchasing Home


Purchase of Other Real Estate


Vehicles - Cars/Boats/Motorcycles/
Trailers/Recreational Vehicles

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Personal Property









Do You Own or Have Any Interest in Any of the Following:






















Other Property Issues




Other Debts-(Estimate if Unknown)








Credit Card Issues
Other Issues

Household Information

Employment-Primary
Employment-2nd Job
Employment-Spouse
Employment-Spouse 2nd Job
Other Income
Monthly Expenses-do Not Include Past Due Amounts

*Additional information will be required before a final recommendation will be made by attorney/counselor