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Four Convenient Office Locations - Honolulu, Aiea, Kaneohe, Maui
Questionnaire

Your path to financial freedom starts here. Get in touch with the experienced bankruptcy attorneys at the Law Offices of Blake Goodman today to explore your options.

Please Fill Out the Form Below

  • Please enter today's date.
  • Please make a selection.
  • Please enter your first name.
  • Please enter your last name.
  • Please enter your spouse's first name.
  • Please enter your spouse's last name.
  • Please enter your address.
  • Please enter your phone number.
    This isn't a valid phone number.
  • Please enter your work phone number.
    This isn't a valid phone number.
  • Please enter your email address.
    This isn't a valid email address.

Employer


  • Please enter the name of your employer and your position.
  • Please enter the name of your spouse's employer and position.

Questionnaire


  • Please make a selection.
  • Please enter how long have you lived at your current address.
  • Please make a selection.
  • Please make a selection.
  • Please make a selection.
  • Please make a selection.
  • Please make a selection.
  • Please make a selection.
  • Do you have any of the following property?

  • Please make a selection.
  • Please make a selection.
  • Please make a selection.

Income

What is your approximate take home income per month (not per pay period) after deductions for taxes, social security, and insurance?
(Please include spouse's income whether filing a case with you or not)


  • Please enter the amount of income from your first job.
  • Please enter the amount of income from your spouse's first job.
  • Please enter the amount of income from your second job.
  • Please enter the amount of income from your spouse's second job.
  • Please enter the amount of income from your business.
  • Please enter the amount of income from your spouse's business.
  • Please enter the amount of income from food stamps.
  • Please enter the amount of income from your spouse's first job.
  • Please enter the amount of child support you receive.
  • Please enter the amount of child support your spouse receives.
  • Please enter the amount of retirement income you receive.
  • Please enter the amount of retirement income your spouse receives.

Other Sources


  • Please enter the amount of other income you receive.
  • Please enter the amount of other income your spouse receives.

Special Deducations


  • Please make a selection.

You


  • Please enter the amount of your monthly retirement contribution.
  • Please enter the amount of your monthly repayments on loans to employer.
  • Please enter the amount of your monthly allotments to creditors.

Your Spouse


  • Please enter the amount of your spouse's monthly retirement contribution.
  • Please enter the amount of your spouses monthly repayments on loans to employer.
  • Please enter the amount of your spouses monthly allotments to creditors.

Expenses

What are your approximate expenses per month for the following items?
  • Please enter the amount of your monthly mortgage/rent.
  • Please enter the amount of your second monthly mortgage.
  • Please enter the amount of your third monthly mortgage.
  • Please enter the amount of your monthly maintenence fee.
  • Please enter the amount of your monthly out of pocket medical expenses.
  • Please enter the amount of your monthly electricity expense.
  • Please enter the amount of your monthly laundry expenses.
  • Please enter the amount of your monthly water expenses.
  • Please enter the amount of your monthly haircut expense.
  • Please enter the amount of your monthly gas expenses.
  • Please enter the amount of your monthly cable expenses.
  • Please enter the amount of your monthly telephone expense.
  • Please enter the amount of your monthly clothing expenses.
  • Please enter the amount of your monthly car payment.
  • Please enter the amount of your monthly car insurance payment.
  • Please enter the amount of your monthly child support payment.
  • Please enter the amount of your monthly food expenses.
  • Please enter the amount of your monthly child car expenses.
  • Please enter the amount of any other monthly expenses.

Mortgages and Other House Related Debts


  • Please enter the name of your real estate creditor #1.
  • Please enter the amount of your outstanding balance to real estate creditor #1.
  • Please enter the value of your piece of real estate.
  • Please enter the name of your real estate creditor #2.
  • Please enter the amount of your outstanding balance to real estate creditor #2.
  • Please enter the value of your piece of real estate.
  • Please enter the name of your real estate creditor #2.
  • Please enter the amount of your outstanding balance to real estate creditor #3.
  • Please enter the value of your piece of real estate.

Car Debts


  • Please enter the name of your auto creditor #1.
  • Please enter the amount of your outstanding balance to auto creditor #1.
  • Please enter the year and type of car #1.
  • Please enter the name of your auto creditor #2.
  • Please enter the amount of your outstanding balance to auto creditor #2.
  • Please enter the year and type of car #2.
  • Please enter the name of your auto creditor #3.
  • Please enter the amount of your outstanding balance to auto creditor #3.
  • Please enter the year and type of car #3.

Credit Cards


  • Please enter the name of your credit card creditor #1.
  • Please enter the amount of your outstanding balance to credit card creditor #1.
  • Please enter the name of your credit card creditor #2.
  • Please enter the amount of your outstanding balance to credit card creditor #2.
  • Please enter the name of your credit card creditor #3.
  • Please enter the amount of your outstanding balance to credit card creditor #3.

Signature Loans With Collateral


  • Please enter the name of your collateral loan creditor #1.
  • Please enter the amount of your outstanding balance to collateral loan creditor #1.
  • Please enter the name of your collateral loan creditor #2.
  • Please enter the amount of your outstanding balance to collateral loan creditor #2.
  • Please enter the name of your collateral loan creditor #3.
  • Please enter the amount of your outstanding balance to collateral loan creditor #3.

Signature Loans Without Collateral


  • Please enter the name of your signature loan creditor #1.
  • Please enter the amount of your outstanding balance to signature loan creditor #1.
  • Please enter the name of your signature loan creditor #2.
  • Please enter the amount of your outstanding balance to signature loan creditor #2.
  • Please enter the name of your signature loan creditor #3.
  • Please enter the amount of your outstanding balance to signature loan creditor #3.

Medical Bills


  • Please enter the name of your medical bill creditor #1.
  • Please enter the amount of your outstanding balance to medical bill creditor #1.
  • Please enter the name of your medical bill creditor #2.
  • Please enter the amount of your outstanding balance to medical bill creditor #2.
  • Please enter the name of your medical bill creditor #3.
  • Please enter the amount of your outstanding balance to medical bill creditor #3.

Student Loans


  • Please enter the name of your student loan creditor #1.
  • Please enter the amount of your outstanding balance to student loan creditor #1.
  • Please enter the name of your student loan creditor #2.
  • Please enter the amount of your outstanding balance to student loan creditor #2.
  • Please enter the name of your student loan creditor #3.
  • Please enter the amount of your outstanding balance to student loan creditor #3.

Loans to Family and Friends


  • Please enter the name of your framily/friends loan creditor #1.
  • Please enter the amount of your outstanding balance to family/friends creditor #1.
  • Please enter the name of your family/friends creditor #2.
  • Please enter the amount of your outstanding balance to family/friends creditor #2.
  • Please enter the name of your family/friends creditor #3.
  • Please enter the amount of your outstanding balance to family/friends creditor #3.

Others


  • Please enter the name of your other loan creditor #1.
  • Please enter the amount of your outstanding balance to other creditor #1.
  • Please enter the name of your other creditor #2.
  • Please enter the amount of your outstanding balance to other creditor #2.
  • Please enter the name of your other creditor #3.
  • Please enter the amount of your outstanding balance to other creditor #3.

Back Tax Debt


  • Please enter the name of your back tax debt creditor #1.
  • Please enter the type of your outstanding tax debt to other creditor #1.
  • Please enter the year of your back tax debt to creditor #1.
  • Please enter the balance of your back tax debt to creditor #1.
  • Please enter the name of your back tax debt creditor #2.
  • Please enter the type of your outstanding tax debt to other creditor #2.
  • Please enter the year of your back tax debt to creditor #1.
  • Please enter the balance of your back tax debt to creditor #2.
  • Please enter the name of your back tax debt creditor #3.
  • Please enter the type of your outstanding tax debt to other creditor #3.
  • Please enter the year of your back tax debt to creditor #3.
  • Please enter the balance of your back tax debt to creditor #3.

General Comments


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