New Client Form

To Arrange a Free Initial Consultation with a Bankruptcy Law Center Attorney:

Submit Form.

Please fill in and submit the information below. We will review your information and contact you to arrange an appointment so please make sure the contact information you provide is typed correctly.

Call for Appointment.

503.253.7777 (Oregon)
360.882.7777 (Washington)
More Appointment Info

If you have an emergency please call us immediately:

Oregon: 503.253.7777
Washington: 360.882.7777

General Information

* Full Name:

* State :

Oregon Washington

* County:

*If your county is not listed we may not be able to represent you. Please call our office immediately to determine.

Preferred Contact Number:

* Email Address:

How should we contact you?:

Phone Email Either

If you would like us to call, when would be the best time?

Financial Issues

Any previous bankruptcy filings?

Yes No

Approximate total credit card debt:

Approximate total medical debt:

Bankruptcy can solve different problems. What problems do you have?
Check all that apply:

Tax Debt	Child Support	Student Loan	Garnishment
Foreclosure	Repossession	Lawsuits

Please add any comments or questions that you may have:

Security Code:

Disclaimer
Information on this web site is provided for informational purposes, is not offered as legal advice, and should not be considered as such. Visiting this site and reviewing the information published here does not create an attorney/client relationship, and is not intended to do so.

Privacy Policy
The Bankruptcy Law Center respects your privacy online. Your name and contact information will not be shared with a third party without your consent. Further, any information that may at some point be provided to the Bankruptcy Law Center through this web site will be used only for the stated purpose.

Request
Information

Home | Contact Us | Privacy Policy | Sitemap | Links