Intake Form for Initial Consultation

Arvizu Law Office Intake Form
Full Name*

First NameMiddle NameLast Name
Spouse's name (if applicable)

First NameMiddle NameLast Name
Date of Birth*
Date of Birth Spouse ( if applicable)
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Alternate Phone Number*

Area CodePhone Number
E-mail
Have you been a resident of the State of New Mexico for the past two years?*

YesNo
Have you ever filed bankruptcy before? If yes, which state did you file in and when?*

Current Debt (fill in total amounts owed)
Credit card debt
Medical Bills
Personal Loans
Collection Accounts
Cell phone/Utilities (that you are late on)
Family/Friends
Miscellaneous
Student Loans
Taxes (state and federal)
Child support/Alimony
Court ordered debt/restitution
Leases or contracts
Deficiencies/Repossessions
Has any of your debt been incurred within the past 60 days?*

YesNo
Is anyone suing you at this time or are there any judgments against you?*

YesNo

Arvizu Law Office Intake Form