Financial Survey

In order for Kruszynski Law Office PLLC to better assist you, please describe your debts.  Please list the total amounts owed for each kind of debt.  For instance, if you have more than one credit card, please let the total balance on all of your credit cards.  Please do not include account numbers, your social security number or any other personal identifying information.  Sending that type of personal information through the Internet may be not safe.  Kruszynski Law Office PLLC is not responsible for information that is intercepted or seen by third parties on the Internet.  Please call us at 602-579-1734 if you would like us to fax you the survey.

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Car Loan(s)
Credit Cards
Mortgage(s)
Monthly Rent or Mortgage Payment
Home Equity Loan or Line of Credit
Student Loans
Medical/Dental Bills
Pay-Day Loans
Criminal Fines or Fees
Old Leases
Personal Lines of Credit
Monthly Medical Expenses
Tax Debt
Cell Phone Bills
Daycare Expenses
Gym Memberships
Other Debt
Monthly Income After Taxes
Do you own your home?
Are you behind on your house payments?
Have you tried any debt counseling service?
Is there anything else you would like us to know?
Name
Phone Number
Email Address
Contact Preference
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