Instructions for Completing the Debt Settlement Intake Form

Thank you for choosing Legal Protection Services to assist with your debt settlement needs. This form helps us evaluate your financial situation and develop a legal strategy to reduce or eliminate your debt burden. Please complete it as accurately as possible.

General Guidelines:

Provide Accurate Information – Complete all sections that apply. If a question does not apply, write "N/A" (Not Applicable).
Be Honest & Detailed – The more details you provide, the better we can assess your debt relief options.
Use Additional Pages If Necessary – If more space is needed, attach extra pages.
Gather Relevant Documents– If available, please provide copies of:
- Collection notices or lawsuit paperwork
- Statements from creditors/lenders
- Any existing debt settlement agreements
- Credit reports or financial statements
Confidentiality – All information provided is confidential and will only be used for legal purposes.

Final Steps:

Review your answers for accuracy and completeness.
Sign and date the form where indicated.
Submit the completed form to our office via email, fax, or in person. If you need assistance, please call 833-529-2287.

Once received, our legal team will review your case and contact you to discuss the next steps.

Thank you for trusting Legal Protection Services to help with your debt settlement needs.

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Instructions for Completing the Debt Settlement Intake Form

General Guidelines:

Final Steps:

Contact information

Marital Status:

Current Employment Status:

Monthly Household Income (Approximate):

Monthly Household Expenses (Rent, utilities, food, etc.):

Total Estimated Debt:

Types of Debt (Check all that apply):

If Other Please Specify

Are You Currently Making Payments on Your Debt?

Are You Behind on Any Payments?

Have You Received Any Collection Notices or Lawsuits Related to Your Debt?

What Are Your Primary Goals? (Check all that apply):

If Other Please Specify:

Are You Willing to Make a Lump-Sum Payment to Settle Some or All of Your Debt?

Have You Worked with Another Debt Settlement Company or Attorney?

Have You Ever Filed for Bankruptcy?

Do You Have Any Pending Legal Actions Related to Debt?

Any Additional Information We Should Know About Your Financial Situation?

Attach relevant documents