Questionnaire

Fill out this form as best you can and then press SUBMIT.  It will be emailed to me directly. I will then review it and contact you.

Thanks!

And don't let the length of the Questionnaire bother you.

Most of the questions are simply Yes or No questions.

Name *
Name
Best phone number to contact you at
Best phone number to contact you at
Home address
Home address
Have you been involved in a Bankruptcy in the last 8 years?
Have you lived in Western Washington the preceding 3 years?
Are you self employed?
Are you (or spouse) a disabled veteran, served in the armed forces or performed homeland security defense activities since 1993?
Single, Married, Married but living separately , Defacto Relationship
Have you (or spouse) been previously married in the last 8 years?
Spouse's Name
Spouse's Name
Do you owe money on a home, land or any real estate?
Do you owe money on a car, boat, motorcycle, airplane, etc?
Do you owe any money to the IRS or any other taxing authority?
Do you owe any money to a finance company or credit union?
Do you owe any student loans?
Do you owe any money to a payday loan company?
Do you have any judgments against you?
Do you owe any current or back due child support, alimony, maintenance or property settlement?
Have you cosigned a debt for anyone?
Has anyone cosigned a debt for you?
Do you owe money to any relative?
Have you repaid any money to a relative in the past 12 months?
Does anyone claim you defrauded them?
Does anyone claim that you gave them a false financial statement?
Do you have copies of the last 2 federal income tax returns you have filed?
Have you filed all required federal income tax returns?
Have any tax liens been filed against you?
Have you made any balance transfers between credit cards within the last 90 days?
Do you owe money to a financial institution in which you have funds (checking, savings, cd, etc.)?
Do you believe your debt is primilarly consumer debt or business debt?
Within the last 12 months have you paid any money to relatives
Within the last 12 months have you transferred any property to a relative as payment of a debt?
Within the last 12 months have you been involved in any lawsuit, court action or administrative proceeding
Within the last 12 months has any of your property been repossessed, foreclosed upon, garnished, attached, seized or levied upon?
Within the last 90 days has any creditor set off or otherwise taken anything from any account?
Within the last 12 months has any of your property in the possession of an assignee for the benefit of creditors, court appointed receiver or custodian?
Within the last 24 months have you made a gift to anyone of more than $600?
Within the last 24 months have you given any money or property to a charity totaling more than $600?
Within the last 12 months did you lose anything because of fire, theft, or other disaster or gambling?
Do you have any money , property, furniture, etc. that belongs to another person or that you are holding for the benefit of someone else?
Did you purchase or refinance a car or truck or other vehicle on the past year?
Is any of your property in possession of a pawnbroker, storage company or repairman?
Within the last 12 months have transferred any property or money to anyone concerning the filing of a bankruptcy proceeding?
Within last 12 months did you transfer any property or money to anyone who promised to help you deal with creditors?
With the last 24 months did you sell, trade or otherwise transfer any property to anyone? For example, did you sell a car, a house etc?
Within the last 10 years did you transfer any property or money into a self-settled trust?
Within the last 12 months were any of financial accounts in our name or for your benefit closed, sold, moved or transferred?
For instance, checking, savings, money market or other financial accounts, cds, shares in banks, credit unions, brokerage houses, pension funds, cooperatives, associations or other financial institutions.
Now or within the last 12 months have you had a safety deposit box?
Within the last year have you had a storage unit?
Do you hold or control any property belonging to anyone else?
Has any governmental unit notified you that you might be liable for any violation of any environmental law?
Within the last 4 years have you owned a business as a sole proprietorship, LLC, partnership, corporation or have you been an officer, managing executive of a corporation?
Within the last 2 years have you given anyone a financial statement?
Have you or any of your children been involved in an automobile accident or injured for any reason in the last 2 years?
Is your or spouse's driver's license suspended?
Do you have an interest in a timeshare or vacation plan?
In the last 90 days have you gotten cash advances on your credit cards of more than $750?
In the last 6 months have you borrowed any money from any finance company, pay day loan company or lender?
Yes No Not Sure
If you are renting has your landlord obtained an eviction judgment against you?