Chapter 7 Contact Form

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The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

For most consumers, life before bankruptcy is fraught with financial difficulties. It is important to remember that although bankruptcy is not the first resort, it is best not to wait too long to take action. If you are facing what seems to be insurmountable debt, contact an attorney at once in order the make the best of a bad situation.

Find Out About Chapter 7 Bankruptcy

Chapter 7 bankruptcy offers protection from creditors and debt liquidation so that individuals can make a fresh financial start. Not everyone is eligible to file for bankruptcy under Chapter 7 of the Bankruptcy Code; the lawyers at the Law Offices of Robert M. Geller, P.A. can advise you.

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*First Name

*Last Name

*Email Address

*Phone Number

*Zip

Street Address

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Incident Street Address

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*Incident Zip

Name of business

Type of business (sole proprietorship, partnership, LLC, LLP, corporation, etc.)

Business address

Person and address to which correspondence should be sent

Additional contact information for responsible party (phone, fax, cell phone, alternate phone, e-mail, etc.)

Best time and way to reach you

Date of incorporation or when business began

State of incorporation, if applicable

States in which licensed to do business

Any other fictitious business names used

Corporate affiliates (parent and/or subsidiary companies)

General counsel's name and contact information

List all assets of the company below.

Type of Asset	Value	Amount Owed
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$

List all liabilities of the company below.

Creditor	Amount Owed	Amount Past Due
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$
	$	$

Total gross income for last fiscal year
$

Total net income for last fiscal year
$

Income expected this fiscal year:

Gross
$

Net
$

Additional relevant information

Special concerns

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