Contact Information

*First Name

*Last Name

*Phone Number

*Email Address

*When is the best time to contact you?

*Have you filed a Proposal or Bankruptcy before?
YesNo

Family Situation

*Number of people in family including yourself

Debt Obligations

*What is your total Debt?

*What types of Debt do you have?

If you have Student Loans – When did you finish School ?

Income

*What is your total monthly income?

*From What Source:
Full Time JobPart Time JobsUnemployment BenefitsSocial Assistance/Ontario Works/ODSPPension Income/CPP/OASChild or Spousal SupportNo Income at AllOther

Assets

*Do you own a house?
YesNo

*Is there a mortgage
YesNo

*Do you have a Motor Vehicle
YesNo

*Is the vehicle financed
YesNo

*Any Investments including RRSPs
YesNo

Any Other assets