Cal West Law
21800 Oxnard Street Suite 720,
Woodland Hills, CA 91367
(818) 788-5008
The intake form is designed to help us understand your case. Please fill out the form completely.
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How were you referred to us?
Friend or family member
Full name?
Another attorney
Full name?
Online search or lawyer directory website
Other
Please explain how you found us:
Google search
Bar association
Which Bar Association?
Radio or TV advertisement
What radio or TV station?
Yelp
Have you ever filed for bankruptcy?
Yes
When did you file?
Where was the case filed?
Under which chapter?
Case number?
Was the case discharged?
No
Provide your complete social security number.
Have you ever been convicted of a Felony?
Yes
When were you convicted?
What was it for ?
No
What is your current marital status?
Married
What is your Spouse's Name?
When did you get married?
Divorced
When did your divorce finalize?
Do you have a court order?
Separated
When did you separate?
Have you filed for divorce?
Single
Widowed
Other
Give specific information
If married, Are you and your spouse filing together?
Yes
No
Do you have children?
Yes
How many Children live at home?
What are their ages ?
No
DEBTS
How much do you owe to unsecured creditors? Please provide an estimated total amount. For example: credit cards, medical bills, etc.
EXPENSES
Estimated Household Expenses?
ASSETS
Do you rent your residence?
Yes
What is your monthly payment?
Are you behind on payments?
Has your landlord obtained an eviction judgment against you?
No
Do you own or have any interest in a residence, building, land, or similar property? This includes anything that is permanently attached to land.
Yes
Describe the property. Single-family home,Duplex, multi-unit building,Manufactured or mobile home, Land,Investment property, Timeshare, or Condominium.
When did you purchase the property?
How many loans do you have?
How much do you pay each month?
What is the current payoff amount for your mortgage?
Does your monthly payment include taxes and insurance?
Are you behind on any payments?
No
Are you responsible for Homeowners Association payments?
Yes
What is the monthly fee ?
Are you behind on any payments?
How much do you owe?
No
Are you currently at risk of losing your home due to foreclosure?
Yes
Property address?
Have you received a notice of sale?
When is the sale date?
What is the trustee sale number?
No
Do you own or have an interest in any type of vehicle?
Yes
How many cars?
Do you plan on keeping the vehicle(s)?
Does anyone else have an interest in these car(s)?
No
INCOME
Source of income?
WAGES
What's your Employers Company Name?
Address?
What is your Job Title?
How long have you worked for this company?
SOCIAL SECURITY BENEFITS
How much do you receive monthly?
SELF EMPLOYED
How much do you estimate you make monthly?
Business Name?
What is the Business address?
Nature of the business?
When was the business opened?
if closed, when did it close ?
Are there any outstanding accounts receivable owed to the business?
PENSION
How much do you receive monthly?
COMMISSION
How much do you receive monthly?
ROYALTIES
How much do you receive monthly?
DIVIDENDS
How much do you receive monthly?
RENTALS
How much do you receive monthly?
Do you have a rental agreement?
UNEMPLOYMENT
How much do you receive monthly?
Other
What is the source of income?
FAMILY SUPPORT Examples: Past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, property settlement.
Support type?
How much do you receive monthly?
If married, Source of Spouse's income?
UNEMPLOYMENT
How much do you receive monthly?
Other
What is the source of income?
FAMILY SUPPORT Examples: Past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, property settlement.
Support type?
How much do you receive monthly?
WAGES
What's your Employers Company Name?
Address?
What is your Job Title?
How long have you worked for this company?
SOCIAL SECURITY BENEFITS
How much do you receive monthly?
SELF EMPLOYED
How much do you estimate you make monthly?
Business Name?
What is the Business address?
Nature of the business?
When was the business opened?
if closed, when did it close ?
Are there any outstanding accounts receivable owed to the business?
PENSION
How much do you receive monthly?
COMMISSION
How much do you receive monthly?
ROYALTIES
How much do you receive monthly?
DIVIDENDS
How much do you receive monthly?
RENTALS
How much do you receive monthly?
Do you have a rental agreement?
Do you have any Lawsuits, wage attachments or garnishments?
Yes
Who is suing you?
How many checks have they garnished?
No
Is there anything else you'd like to add about your income?
INCOME TAX DEBTS
Income tax debt can be eliminated if the tax returns were filed over 3 years ago from the due date (additional requirements apply to eliminate tax debt).
Do you owe income taxes?
Yes
Which year(s)?
How much do you owe the Franchise Tax Board (State)?
How much do you owe the Internal Revenue Service (IRS)?
When did you file the taxes owed?
No
Is there anything else you would like to add?