The Williams Law Office, LLC
3675 Crestwood Pkwy., Suite 400 - Duluth, Ga 30096
Located Just Off The Pleasant Hill Road Exit on I-85, Between I-285 and 316
678-734-9745

Appointments Also Available in Loganville

 

   ONLINE PRELIMINARY CASE EVALUATION


Thank you for choosing to submit this information. We will keep it it in the strictest of confidence, and use it to conduct a free confidential preliminary evaluation of your prospective case. This does not obligate you in any way, and does not create any attorney-client relationship. (If you later decide to hire our firm to assist you, we will meet with you and sign a contract to begin a formal legal relationship.)

     Please fill out this form with as much detail as possible. Remember that all numbers asked for are monthly, not annual. When you have finished filling out this form, return it to us for an attorney to review. We look forward to helping you achieve your financial goals and get a fresh start to a better financial future.

    Click inside one of the form fields with your mouse to immediately begin typing your responses. For questions with a “yes” or “no” required response, please check the proper box by clicking your mouse to provide the proper response.

 

Date

Total Number of People Living
in Your Household

Your Name

Name of Spouse (if applicable)

Address

City

State

Zip

Home Phone

Work

Cell

Email Address

Please answer the following "yes" and "no" questions. All information will be kept in the strictest confidence.
Do you own a home or other real estate?  YES  NO
Are you behind in your mortgage payments?  YES  NO
-----If so, how many months are you behind?

Months
Do you own a mobile home?  YES  NO
Do you receive bonuses at your work?  YES  NO
Do you receive commissions or tips at your work?  YES  NO
Do you own any cars, motorcycles, vans, RVs or other vehicles?  YES  NO
-----if so, how many vehicles do you own outright or make payments on?

Vehicles
Have you filed all of your income tax returns for this year and the past 3 years?  YES  NO
Do you owe the IRS any past due taxes?  YES  NO
Do you owe any unpaid state taxes?  YES  NO
Do you owe any unpaid property taxes?  YES  NO
Do you owe on a student loan?  YES  NO
Have you borrowed money from your IRA or other retirement plan to pay bills?  YES  NO
Have you received any cash advances within the past 3 months?  YES  NO
Do you have any loans with a credit union where you work?  YES  NO
Are you leasing any buildings or equipment?  YES  NO
Does an ex-spouse have a claim against you for any reason?  YES  NO
Do you owe money on the purchase of jewelry, furniture or other household goods?  YES  NO
Have you experienced, or do you expect to experience a foreclosure or repossession?  YES  NO
Are you in the process of suing someone?  YES  NO
Does anyone want to sue you or have they already filed a lawsuit against you?  YES  NO
Does anyone have a claim against you due to a car accident?  YES  NO
Have you used your credit cards to make purchases within the past 90 days?  YES  NO
During the past 2 years, have you owned or had an interest in any business?  YES  NO
Have you ever made money on the internet selling or trading?  YES  NO
Have you transferred any property with a retail value of $600 or more within the past 4 years?This includes homes, motor vehicles and other assets.  YES  NO
Have you stopped using all your credit cards?  YES  NO
Do you have any credit cards you want to hold on to for an emergency?  YES  NO
Have you ever filed bankruptcy before?  YES  NO
Are you behind in child support?  YES  NO
Do you have any payday loans you still owe money for?  YES  NO
Have you closed any bank accounts and left owing a balance?  YES  NO
Do you have any bounced checks you owe additional fees for?  YES  NO
Do you have any co-signers for your debts other than your spouse (if applicable)?  YES  NO
Have you co-signed a loan for anyone other than your spouse (if applicable)?  YES  NO
Have you ever been convicted of any crime?  YES  NO
Are you currently paying any court fines?  YES  NO
Are your wages currently being (or are soon to be) garnished?  YES  NO
Do you have any judgments against you from any lawsuits that you lost?  YES  NO
Do you have any lawsuits against you where the case is still pending?  YES  NO
Do you have CDs, stocks, bonds or other types of financial accounts?  YES  NO
Are you self-employed?  YES  NO
-----If so, how long have you been self-employed?

Months
Are you currently drawing unemployment, retirement and/ or social security disability?  YES  NO
Are you only making the minimum payments on your credit cards?  YES  NO
Do you charge essential living expenses like groceries, gas and utilities?  YES  NO
Are you taking out cash advances on your credit cards to provide you with cash to pay essential living expenses?  YES  NO
At the end of the month, do you have to charge essential living expenses?  YES  NO
Are you receiving collection letters and/or telephone calls about your delinquent bills?  YES  NO
Are creditors threatening to sue you?  YES  NO
Do you avoid answering the telephone because you fear it will be bill collectors?  YES  NO
Do you skip paying some bills in order to have money to cover essential living expenses?  YES  NO
Are you continuing to get new credit cards to cover essential living expenses?  YES  NO
Are you borrowing money from friends/family to cover your debts?  YES  NO

YOUR INCOME
How much money do you bring home every paycheck (after taxes)?

$

How often do you get paid?  WEEKLY  TWICE A MONTH  MONTHLY  EVERY 2 WEEKS
How much money does YOUR SPOUSE bring home every paycheck (after taxes)?

$

How often does YOUR SPOUSE get paid?  WEEKLY  TWICE A MONTH  MONTHLY  EVERY 2 WEEKS
How much social security do you receive per month?

$

How much child support do you receive per month?

$

How much retirement income do you receive per month?

$

How much additional money do you earn per month?

$


MONTHLY LIVING EXPENSES
Please provide an AVERAGE amount that your household pays PER MONTH for the following expenses:
Mortgage or Rent

$

Garbage Pick-Up

$

Electricity

$

Lawn Maintenance

$

Water and sewer

$

Pool Maintenance

$

Home Phone

$

Other Expenses

$

Cell Phone

$

Recreation

$

Food

$

Motor Vehicle Payment #1

$

Clothing

$

Motor Vehicle Payment #2

$

Laundry

$

Motor Vehicle Payment #3

$

Gasoline for Motor Vehicles

$

Student Loan

$

Home/Renters Insurance

$

Furniture Payment

$

Life Insurance

$

Jewelry Payment

$

Auto Insurance

$

Boat and RV

$

Income Taxes(If not deducted from paycheck)

$

Child Care

$

Real Estate Taxes(If not included in mortgage payment)

$

Infant Expenses

$

Past Due Taxes

$

Payments to a family member

$

How much money do you spend paying credit cards every month?

$

What specific debts are you having the most difficult time with?
Do you expect to lose your job any time soon?  YES  NO
Do you expect your income or expenses to change in the near future?  YES  NO
Are you paying expenses for someone other than your legal dependent(s)?  YES  NO
STATEMENT OF ACCURACY & AGREEMENT
 YES

IMPORTANT: CHECK BOX IF YOU AGREE TO THE FOLLOWING STATEMENT: By checking this box, I/we state the information on this ONLINE PRELIMINARY CASE EVALUATION Form is true and correct to the best of my/our knowledge. I/We understand that providing inaccurate information can detrimentally affect my/our case, cause an undue outcome or result in charges brought against me/us if convicted of fraud. I/We also understand the information provided in this Form will not be shared with any other party, other than attorneys who have the knowledge to legally advise me/us and authorized parties assigned by the attorneys to work on my/our case if I/we hire your firm. I/we agree that by filling out this form and receiving a free evaluation, no attorney-client relationship is created, and that you do not accept any new clients without an in-person meeting, payment of a retainer, and signing of a bilateral contract.

Best time(s) to call to discuss your case:

Best phone number(s) to reach you at: 

FOR LAW FIRM USE ONLY: Date Submitted ________ Date Reviewed _________
Reviewed By __________