Business or Consumer Debtor Analysis Form

After reading through our Bankruptcy Information Center, fill out the Business or Consumer Debtor Analysis Form and send it to the Law Office of Jon B. Clarke.

After reading through our Bankruptcy Information Center, fill out the Business or Consumer Debtor Analysis Form and send it to the Law Office of Jon B. Clarke.

Business or Consumer Debtor Analysis Form (the “BCD Form”)

After you have read through this website and the links found on our Bankruptcy Information Center and Web Resources pages, you should fill out the following Business or Consumer Debtor Analysis Form (the “BCD Form”) and submit it to the Law Office of Jon B. Clarke. The 2005 Bankruptcy Code mandates different (and simpler) intake procedures for clients who are “business debtors” as distinct from “consumer debtors”. You can email the BCD or fax it to the firm (303-850-7115). Remember that email is not secure and there is a small chance that the information you send could be viewed by another person.

Information Collection, Use and Sharing

This firm is the sole owner of the information collected on this site. This firm alone will have access to information that you voluntarily give us via email or other direct contact. This firm will not sell or rent this information to anyone. The firm will use your information to respond to you, regarding the reason you contacted it. The firm will not share your information with any third party outside of our organization, other than as necessary to pursue your desire to obtain debt relief.

Links

This website contains links to other sites. Please be aware that this firm is not responsible for the content or privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of any other site that collects personally-identifiable information.

Confidential or time-sensitive information should not be sent through this email link. If your situation is urgent, please call (303) 779 – 0600 .  If Mr. Clarke is available he will take your call. If not, briefly explain the urgency of your situation to his receptionist or legal assistant, or you may leave a voice mail. Thereafter, please complete the form below and fax or email it to the firm.

An asterisk (*) indicates REQUIRED information.

*Name of prospective client (the "debtor"):

The prospective client is: (check all that apply)

Individual(s) with only consumer debts

Individual(s) with both business and consumer debts

Owner of a sole proprietorship business

General partnership

Limited partnership

Limited liability company

S corporation

C corporation

Owner of Income Property - Residential

Owner of Income Property - Commercial

Does the debtor own real estate?

Type:

ResidenceSecond residenceTimeshare unitRental Home(s)

Office buildingIndustrial/Warehouse buildingRaw land

Primary residence real estate market value: $
Primary residence First mortgage payoff amount/Monthly Payment $
Primary residence Junior mortgage payoff amount/Monthly Payment $
Secondary residence real estate market value: $
Secondary residence First mortgage payoff amount/Monthly Payment $
Secondary residence Junior mortgage payoff amount/Monthly Payment $
Combined Rental Houses market value: $
Combined Rental Houses mortgage payoff amount $
Combined Rental Houses monthly profit $
Combined Rental Houses monthly loss $
Is the debtor a tenant in rental real estate? YesNo

Type:
ResidenceOfficeStoreIndustrial/Warehouse

Monthly rent payment: $
Rent arrearage, if any: $
Months left on the lease: $

Business Personal Property (supply estimated liquidation value)

Furniture, fixtures, equipment, inventory, accts receivable value: $
Seller-carried loan balance: $
Bank/SBA loan balance: $

Consumer Personal Property
(use current replacement/retail value)

Value of all vehicles: $
Value of other personal property: $
Vehicle loan or lease payoff total: $
Personal property loan or lease payoff total: $

The Priority Debts Debtor Owes:

Employee Wages: $
Customer Deposits or pre-payments: $
Payroll Taxes: $
Sales & Unemployment Taxes: $
Income Taxes: $
Last year for which a federal income tax return was filed:
Wage income on this return $
Business (schedule C, E) income/loss on this return: $

Unsecured Debt Balances:

Credit Cards - Consumer use: $
Credit Cards - Business use: $
Other Consumer Debts (Medical, Student loan): $
Business Trade Creditors and Vendor Debts: $
Permanently-guaranteed business trade Creditor/Vendor Debts: $

Name of Person to Contact?:

How should we contact you? (more than one can be checked)

By email at the sender's email address:
At home telephone:
At work telephone:
On a cell phone:
Best time to contact you:

Why do you need our help?

DISCLAIMER: The information you have obtained from this website is not, nor is it intended to be, what is commonly called "legal advice". Pursuant to the 2005 Act, this firm must determine your status as a business or consumer debtor and provide certain disclosures and notices before it can give meaningful, personalized "legal advice" to any individual or business entity.