Bankruptcy Intake Form

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All information provided is 100% confidential. Your submission form is sent directly to Jim Williams and staff. We will contact you within 24 hours once the form has been submitted.

Your Name (First, Middle, Last)

Your Email Address

Preferred Contact Number

What state do you live in?
Tennessee Virginia 

Marital Status: Single Separated Married Divorced 

Are you facing foreclosure, wage garnishment, repossessions? Yes No 

Additional Information:

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