DEAN GREER, P.C. Take the First Step TowardFinancial Relief All information submitted to Dean Greer is confidential and not shared outside this office. Confidential No Obligation No Documents Yet About 5 Minutes Step 1 of 6 17% 1About You2Financial Stress3Household & Income4Home, Vehicles & Debt5Urgent Issues6Consultation Step 1 of 6Full NameBest Phone NumberAddress Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email Address Best Way to Reach YouPhone CallText MessageEmailBest Time To Reach YouAnytimeMorningAfternoon Great — you’re startedStep 2 of 6Tap everything that applies. There are no right or wrong answers.What’s causing the most stress right now? Credit Card Debt Medical Bills Collection Calls Collection Letter Lawsuit Wage Garnishment Foreclosure / Behind on House Payment Vehicle Repossession / Behind on Car Payment Frozen Bank Account Tax Debt Student Loans Payday Loans Personal Loans Business Debt Divorce Related Debt Other I'm Not Sure If you answered other, please provide a brief descriptionGood news: Bankruptcy may be able to stop a foreclosure and provide time to catch up missed payments. Good news: Bankruptcy often stops wage garnishments after a bankruptcy case is filed. Step 3 of 6Marital StatusSingleMarriedDivorcedSeparatedWidowedHow many people live in your household, including you?123456+How many children or dependents do you support?01234+Employment StatusFull-TimePart-TimeSelf-EmployedRetiredDisabledUnemployedOtherName of your business?Briefly describe the nature of your business.Other income received Social Security Disability Pension / Retirement Child Support Alimony Veteran Benefits Rental Income None Other You’re over halfway there. Just a few more details and we’ll take it from there. Step 4 of 6Do you own a home or land?NoYesAre you behind on mortgage payments?No1-2 Months3-6 MonthsMore than 6 monthsUnsureIs there a foreclosure sale?NoYesUnsureHow many vehicles do you own?None123 or moreAre any vehicles financed or leased? Yes No Unsure Are you behind on vehicle payments? Yes No Unsure Has a vehicle been repossessed or threatened with repossession? Yes No Unsure Estimated total of credit cards, medical bills, personal loans, collections, and other unsecured debts. Do not include your mortgage or car loans.Less than $10,000$10,000 - $24,999$25,000 - $49,999$50,000 - $99,999$100,000 - $199,999$200,000+Unsure Almost done — just a few important questions left. Step 5 of 6Have you filed bankruptcy before?NoYes - Chapter 7Yes - Chapter 13Yes - Not sure which ChapterWhen was the bankruptcy filed? Month Day Year If unsure, please check here Unsure of date bankruptcy was filed Have you been sued by a creditor? Yes No Unsure Are your wages being garnished? Yes No Has your bank account been frozen? Yes No Do you owe the IRS or state taxes? Yes No Unsure Do you owe child support or alimony? Yes No Unsure Within the last 2 years, have you: Sold Real Estate Gave Away Real Estate Transferred Property to Family or Friends Received Inheritance Received a Lawsuit Settlement Received Life Insurance Money None of these Unsure Excellent. One final step and your assessment is ready to submit. Step 6 of 6Preferred Consultation TypePhoneOffice VisitNo PreferenceIs there anything else you would like us to know? You’re All Set. Your Financial Relief Assessment has been received. A member of our team will review your information and contact you to discuss your options. If you are facing a foreclosure sale, vehicle repossession, wage garnishment, frozen bank account, or a court hearing within the next 14 days, please call our office immediately after submitting this form. Δ
