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Business or Consumer Debtor Analysis Form

Business or Consumer Debtor Analysis Form

Contact Us

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 liability company

S corporation

C corporation

Owner of Income Property - Residential

Owner of Income Property - Commercial

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Does the debtor own real estate? Type:

Type:

Residence

Second Residence

Timeshare unit

Rental Home(s)

Office building

Industrial/Warehouse building

Raw 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?

Yes

No

Type:

Residence

Office

Store

Industrial/Warehouse

Monthly rent payment: $

Rent arrearage, if any: $

Months left on the lease: $

Business Personal Property (supply estimated liquidation value)

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: $

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The Priority Debts Debtor Owes

Employee wages: $

Customer deposits or pre-payments: $

Income Taxes: $

Payroll Taxes: $

Sales & Unemployment Taxes: $

Income Taxes: $

Last year for which a federal income tax return was filled: $

Wage income on this return: $

Trade Creditors (business vendors): $

Business (schedule C,E) income/loss on this return: $

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Unsecured Debt Balances:

By email at the sender's address:

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: $

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Contact

Name of Person to Contact?

How should we contact you?

Email

At home telephone

Cell

Best time to contact you

Why do you need our help?

Thank you for contacting us.
We will get back to you as soon as possible.

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Contact info

Phone: (970) 240-2812

Fax: (970) 240-2860

Office Location

144 S. Uncompahgre Ave.

Montrose, CO 81402

Hours

Hours – 8:30am to 5:00pm

Monday thru Friday

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