Your Name (required)

    Your Email (required)

    Your Phone Number (required)

    Please describe your present financial hardship and the events that caused it.

    What is motivating you to take action to resolve your current financial predicament?

    What are your financial goals moving forward?

    Have you considered filing for Bankruptcy?

    How much unsecured debt do you have?

    What would you like to learn during your consultation with Mr. Day?

    What is the best time to reach you to schedule the consultation?