Lombardo Law Offices is Accepting New Clients! We are offering Over the Phone Bankruptcy Consultations.

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Intake Form

Before we get started on a Consultation, we will need you to fill out this intake form. Feel Free to call us if you have any questions: (414) 543-3328

Intake Form

Your Information
Your Name*
First Middle Last
Marital Status*
- Single
- Married
- Divorced
- Separated
- Widowed
Other names you've used in the last 6 years
Your Date Of Birth*
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your County of Residence*
Your Home Phone*
Your Cell Phone
Your Email*
Occupation*
Name/ Address of Employer:*
Length of Employment:*
How did you hear about us?*
- Postcard
- TV Weekly Shopper/Redbook
- Yellowpages
- Internet
- Referral
Your Spouse's Information
Spouse's Name
First Middle Last
Other names your spouse used in the last 6 years
Spouse's Date Of Birth
Spouse's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Spouse's County of Residence
Spouse's Home Phone
Spouse's Cell Phone
Spouse's Occupation
Name/ Address of Employer of Spouse:
Spouse's Length of Employment:
Bankruptcy Questions
Have you filed for bankruptcy within the last 8 years?*
- Yes
- No
If yes, Fill Out the Fields Below*
Location Where Filed Case Number Date Filed
Do you or your spouse or your children have a Personal Injury Claim of any kind?*
- Yes
- No
Have you or spouse had a lawyer represent you before?*
- Yes
- No
Divorced?*
- Yes
- No
Married now?*
- Yes
- No
Do you have any interest in real estate of land or anyone else's bank account?*
- Yes
- No
Enter the Types of Debt You Have
Just estimate the amount to the best of your ability
Credit Card Debt
Tax Debt
Accident w/o Insurance
Medical Debt
Student Loans
Lawsuits
NSF Checks
Check Loans
Tickets
Past Due Utilities
Repossessions
Foreclosures (Now or Past)
Child Support
Personal or Bank Loan
Mortgage/Home Equity/Time Share
Current Income
Just estimate the amount to the best of your ability
List all dependants of you and your spouse, their ages, and relationship to you
Name Age Relationship
I Get Paid*
- Weekly
- Bi-Weekly
- 2x/Month
- Monthly
Income (gross Pay)*
Overtime Income*
My Spouse Gets Paid
- Weekly
- Bi-Weekly
- 2x/Month
- Monthly
Spouse's Income (gross Pay)
Spouse's Overtime Income
Other Income
Alimony Social Security Unemployment Pension Property / Rental Income from Operation of Business Other Income:
Spouse's Other Income
Alimony Social Security Unemployment Pension Property / Rental Income from Operation of Business Other Income:
Do you expect any changes in your income or expenses over the next year? If so, please explain below:
Current Monthly Expenses
Do you and your spouse maintain separate households?*
- No
- Yes
The following questions ask for your expenses each month. If you are unsure of the amount you pay each month, but know the amount for a different period (per week, per day, every 2 months, etc.) write the amount and the frequency that you pay the amount. Indicate how much you pay for each item each month:
1st Household
1. Your Rent or your home mortgage
Does that amount include real estate taxes
- yes
- no
Does it include property insurance?
- yes
- no
2. Electricity and heating
3. Water and Sewage
4. Telephone service / long distance
5. Cable/ Satellite
6. Cell Phone
7. Home maintenance, including repairs and general upkeep
8. Food
9. Clothing
10. Laundry and Dry Cleaning
11 . Medical and Dental Expenses
12. Transportation
13. Entertainment, Recreation, Newspapers, Magazines
14. Charitable Contributions
15. Insurance not deducted from paycheck
a. Homeowner's or Renter's insurance b. Life insurance c. Health insurance d. Auto insurance
Other Insurance not deducted from paycheck
Insurance type Amount
16. Taxes not deducted from paycheck
17. Installment payments for car, furniture, etc.
Type Amount
18. Alimony, maintenance, support paid to others
19. Payments for support of dependants not living at home
20. Expenses from operation of business
21. Other expenses not listed above such as pet care or hair care:
2nd Household
1. Rent or home mortgage:
Does that amount include real estate taxes
- Yes
- No
Does it include property insurance?
- Yes
- No
2. Electricity and heating
3. Water and Sewage
4. Telephone service / long distance
5. Cable/ Satellite
6. Cell Phone
7. Home maintenance, including repairs and general upkeep
8. Food
9. Clothing
10. Laundry and Dry Cleaning
11 . Medical and Dental Expenses
12. Transportation
13. Entertainment, Recreation, Newspapers, Magazines
14. Charitable Contributions
15. Insurance not deducted from paycheck
a. Homeowner's or Renter's insurance b. Life insurance c. Health insurance d. Auto insurance
Other Insurance not deducted from paycheck
Insurance type Amount
16. Taxes not deducted from paycheck
17. Installment payments for car, furniture, etc.
Type Amount
18. Alimony, maintenance, support paid to others
19. Payments for support of dependents not living at home
20. Expenses from operation of business
21. Other expenses not listed above such as pet care or hair care:
Type Amount

Location Where Filed	Case Number	Date Filed

Name	Age	Relationship

Intake Form

Your Information

Your Spouse's Information

Bankruptcy Questions

Enter the Types of Debt You Have

Current Income

Current Monthly Expenses

1st Household

2nd Household