Please fill out this short questionnaire to determine whether you are eligible for a Free Bankruptcy. After the questionnaire is submitted you will be contacted by a member of the Debt Relief Foundation regarding your eligibility

A value is required. A value is required.Invalid format. A value is required.

Do you own real property? Please select an item.
   
If you have any investments such as, 401k, 403B, IRA, CD, stocks, bonds, trusts, retirement, pension or any others, select and include current value for each. For additional investments, use the Addional Information box below.
$
$
$
   
List all vehicles and appoximate value.
For additional vehicles, use the Addional Information box below.
Vehicle 1 $
Vehicle 2 $
Vehicle 3 $
Vehicle 4 $
   
Bank accounts? List bank name, account type and current balance.
For additional accounts, use the Addional Information box below.
bank name 1 $
bank name 2 $
bank name 3 $
bank name 4 $
   
Please describe all income for every person in the household.
For additional income, use the Addional Information box below.
Please select an item.
Please select an item. $
Please select an item. $
Please select an item. $
   
Does anyone in your family loan or gift you money? Please list at right.
For additional income, use the Addional Information box below.
$
$
$
   
total amount of debt $

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A value is required.

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