• CONTACT INFORMATION

    THE MACSIM FIRM
    Phone: 561-899-8184
    Facsimile: 561-536-3031
    Email: contact@themacsimfirm.com

    WEST PALM BEACH
    No Walk-Ins. By Appointment Only
    801 Northpoint Parkway
    West Palm Beach, FL 33407

    BOYNTON BEACH
    No Walk-Ins. By Appointment Only.
    1375 Gateway Boulevard
    Boynton Beach, FL 33426

    OFFICE MAILING ADDRESS CORRESPONDENCE ONLY
    P.O. Box 4681
    Boynton Beach, FL 33424

  • BANKRUPTCY EVALUATION


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    THE MACSIM FIRM

    Mailing Address:
    1530 W. Boynton Beach Blvd. Suite 4681
    Boynton Beach, FL 33424


    Office: 561-899-8184 Fax: 561-536-3031
    Website: www.themacsimfirm.com
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    Thank you for choosing our law firm to assist you with your financial needs.  Please fill out this form with as much detail as possible.  All information you provide will be kept in the strictest confidence.  When you have finished filling out this form, click Submit for the attorney to review.  We look forward to helping you achieve your financial goals and get a fresh start to a better financial future.-
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    Date Total Number of People Living
    in Your Household


    Your Name*
    Name of Spouse (if applicable)
    Address


    City State Zip


    Home Phone*
    Email Address*


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    INITIAL INTAKE FORM
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    Please answer the following "yes" and "no" questions. All information will be kept in the strictest confidence.
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    Do you own a home or other real estate? NO 
    Are you behind in your mortgage payments?
    -----If so, how many months are you behind? Months
    Do you own a mobile home?
    Do you receive bonuses at your work?
    Do you receive commissions or tips at your work?
    Do you own any cars, motorcycles, vans, RVs or other vehicles?
    -----If so, how many vehicles do you own outright or make payments on? Vehicles
    Have you filed all of your income tax returns for this year and the past 3 years?
    Do you owe the IRS any past due taxes?
    Do you owe any unpaid state taxes?
    Do you owe any unpaid property taxes?
    Do you owe on a student loan?
    Have you borrowed money from your IRA or other retirement plan to pay bills?
    Have you received any cash advances within the past 3 months?
    Do you have any loans with a credit union where you work?
    Are you leasing any buildings or equipment?
    Does an ex-spouse have a claim against you for any reason?
    Do you owe money on the purchase of jewelry, furniture or other household goods?
    Have you experienced, or do you expect to experience a foreclosure or repossession?
    Are you in the process of suing someone?
    Does anyone want to sue you or have they already filed a lawsuit against you?
    Does anyone have a claim against you due to a car accident?
    Have you used your credit cards to make purchases within the past 90 days?
    During the past 2 years, have you owned or had an interest in any business?
    Have you ever made money on the internet selling or trading?
    Have you transferred any property with a retail value of $600 or more within the past 4 years?

    This includes homes, motor vehicles and other assets.
    Have you stopped using all your credit cards?
    Do you have any credit cards you want to hold on to for an emergency?
    Have you ever filed bankruptcy before? - -
    Are you behind in child support? - -
    Do you have any payday loans you still owe money for? - -
    Have you closed any bank accounts and left owing a balance? - -
    Do you have any bounced checks you owe additional fees for? - -
    Do you have any co-signers for your debts other than your spouse (if applicable)? - -
    Have you co-signed a loan for anyone other than your spouse (if applicable)? - -
    Have you ever been convicted of any crime? - -
    Are you currently paying any court fines? - -
    Are your wages currently being (or are soon to be) garnished? - -
    Do you have any judgments against you from any lawsuits that you lost? - -
    Do you have any lawsuits against you where the case is still pending? - -
    Do you have CDs, stocks, bonds or other types of financial accounts? - -
    Are you self-employed? - -
    -----If so, how long have you been self-employed? Months
    Are you currently drawing unemployment, retirement and/ or social security disability? - -
    Are you only making the minimum payments on your credit cards? - -
    Do you charge essential living expenses like groceries, gas and utilities? - -
    Are you taking out cash advances on your credit cards to provide you with cash to pay essential living expenses? - -
    At the end of the month, do you have to charge essential living expenses? - -
    Are you receiving collection letters and/or telephone calls about your delinquent bills? - -
    Are creditors threatening to sue you? -  NO-
    Do you avoid answering the telephone because you fear it will be bill collectors? - -
    Do you skip paying some bills in order to have money to cover essential living expenses? - -
    Are you continuing to get new credit cards to cover essential living expenses? - -
    Are you borrowing money from friends/family to cover your debts? - -
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    YOUR INCOME
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    How much money do you bring home every paycheck (after taxes)?*
    $--


    How often do you get paid?
    -----TWICE A MONTH ------MONTHLY ------EVERY 2 WEEKS 


    How much money does YOUR SPOUSE bring home every paycheck (after taxes)?*
    $--


    How often does YOUR SPOUSE get paid?
    WEEKLY ------TWICE A MONTH ------MONTHLY ------ EVERY 2 WEEKS-


    How much social security do you receive per month?*
    $--
    How much child support do you receive per month?*
    $--
    How much retirement income do you receive per month?*
    $--
    How much additional money do you earn per month?*
    $--
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    MONTHLY LIVING EXPENSES
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    Please provide an AVERAGE amount that your household pays PER MONTH for the following expenses:



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    Mortgage or Rent $-- ------ Garbage Pick-Up
    $--
    Electricity $-- -------Lawn Maintenance
    $--
    Water and sewer $-- -------Pool Maintenance
    $--
    Home Phone $-- -------Other Expenses
    $--
    Cell Phone $-- -------Recreation
    $--
    Food $-- ----- Motor Vehicle Payment #1
    $--
    Clothing $-- ----- Motor Vehicle Payment #2
    $--
    Laundry $-- ------Motor Vehicle Payment #3
    $--
    Gasoline for Motor Vehicles $-- -------Student Loan
    $--
    Home/Renters Insurance $-- -------Furniture Payment
    $--
    Life Insurance $-- -------Jewelry Payment
    $--
    Auto Insurance $-- -------Boat and RV
    $--
    Income Taxes(not deducted from paycheck) $-- -------Child Care
    $--
    Real Estate Taxes(not included in mortgage payment) $-- -------Infant Expenses
    $--
    Past Due Taxes $-- --Payments to a family member
    $--


    How much money do you spend paying credit cards every month?


    What specific debts are you having
    the most difficult time with?


    Do you expect to lose your job any time soon? - -
    Do you expect your income or expenses to change in the near future? - -
    Are you paying expenses for someone other than your legal dependent(s)? - -


    What goal would you like to achieve
    by hiring this law firm to represent you?
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    STATEMENT OF ACCURACY
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     .

    IMPORTANT: CHECK BOX IF YOU AGREE TO THE FOLLOWING STATEMENT:  By checking this box you state the information on this Initial Intake Form is true and correct to the best of my/our knowledge. I/We understand that providing inaccurate information can detrimentally affect my/our case, cause an undue outcome or result in charges brought against me/us if convicted of fraud. I/We also understand the information provided in this Initial Intake Form will not be shared with any other party, other than attorneys who have the knowledge to legally advise me/us and authorized parties assigned by the attorneys to work on my/our case.


    NOTICE: This office does not represent you with regard to the matters set forth by you herein in this information sheet or discussed during your consultation, unless and until, both you and the Attorney execute a written Agreement for Representation. Your submission acknowledges only that you have received a copy of this completed information sheet and does not mean you have hired the Attorney.

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    THE MACSIM FIRM

    1530 W. Boynton Beach Blvd. Suite 4681
    Boynton Beach, FL 33424


    Office: 561-899-8184
    Fax: 561-536-3031


    Website: www.themacsimfirm.com
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