Provide Your Info

By the time your debt is referred to our firm, it is delinquent and due in full. Moreover, it has been our experience that a single lump sum payment to resolve the debt is most beneficial to both you and the creditor. However, we recognize that in some instances such a resolution is simply not possible. In those cases, we need the detailed financial information requested below to properly consider and accurately determine an acceptable payment plan.

DEMOGRAPHICS:	FCKEditorArea
Your Kohn Law Firm account number:
Full name:
Residence street address:
City,State and Zip Code:
Telephone numbers:
Marital status (Single, Married, Divorced or Separated)?:
Number of dependent children under age 18:
FINANCIAL INFORMATION:	FCKEditorArea
Rent or own residence:
Amount of rent or mortgage payment:
Value of your home:
Amount owed on mortgage:
Name of your employer:
Work telephone number:
Employment status (full time, part time, seasonal):
Monthly take home pay:
Name of your spouse's employer:
Spouse's work telephone number:
Employment status (full time, part time, seasonal):
Spouse's monthly take home pay:
Child support paid (monthly):
Child support received (monthly):
Needs-based assistance received (e.g. food stamps, etc.):
What arrangement do you propose to resolve this debt?:
NOTICE: This communication is from a debt collector:	FCKEditorArea