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What is your zip code?
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Approximately how much student loan debt do you have?
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Approximately how much unsecured debt such as medical, credit card and personal loans do you have? Please do not include auto or student loans.
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Which of the following best represents your approximate unsecured debt?
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Are you sure that you only have $0 in unsecured debt?
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Which of the following is the biggest reason you are considering bankruptcy?
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You are considering bankruptcy on $0 in debt, which is under $7,000, and we would like to do a soft credit pull (which does not affect your credit) to confirm your debt amount. Would that be okay?
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Would you estimate that your total unsecured debt (credit cards, loans, medical debt, other debt etc.) is over $10,000?
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Which of the following describe your unsecured debt? Check all that apply
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We can do a soft credit pull to get a better picture of your debts. The credit report would allow us to give more accurate estimates of how much you would pay in each option you selected. It would NOT affect your credit score. Would it be helpful for us to pull your credit report?
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Do you have an active freeze or lock on your credit with Equifax?
To use this feature, you will need to remove the freeze temporarily. More information: https://www.equifax.com/personal/credit-report-services/credit-freeze/
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To use this feature, you would need to remove the active freeze or lock with Equifax and then click "No" above.

What's Your Legal Name?

First Name
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Last Name
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Suffix (Sr, Jr, I, etc)
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What's Your Address?

What is your current street address?
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What city do you live in?
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Apt/suite number (if applicable)
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What state do you live in?
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What is your zip code?
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Have you moved in the past year and/or have a previous address?
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United States (US)
Update Address
United States (US)
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What's Your Previous Address?

What was your previous street address?
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What city did you previously live in?
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Previous Apt/suite number (if applicable)
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What state did you previously live in?
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What was your previous zip code?
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When's Your Birthday?

Month
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Day
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Year
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What Are The Last 4 Digits of Your Social Security Number?

Last 4 Digits of SSN
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Phone Number
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Thank you for completing this form! You can click submit.

What is your marital status?
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How many people do you take care of in your household (including yourself)?
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You answered there is only one (1) person in your household, but you are married. Please confirm the number of people in your household.
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How many people in your household are 65 or older?
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Are you 65 or older?
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How many of your dependants (excluding a spouse) are over 18 years old?
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What is causing you to consider debt relief?
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Which best describes the debt?
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What best describes why you are considering debt relief?
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What is the status of the divorce?
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Do you have a pending foreclosure sale?
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What is the unexpected expense?
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What is the status of the wage garnishment?
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Have you filed bankruptcy in the past 6-8 years?
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Have you filed a Chapter 7 bankruptcy in the past 8 years?
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Have you filed a Chapter 13 bankruptcy in the past 6 years?
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When would you want to make a decision to pursue debt relief?
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Have you received a quote from any of the following services?
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Which of the following is the name of a debt relief firm?
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Debt Relief Firm Name
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Debt relief companies are notorious to state the pros but downplay the cons. Which of the following cons did they NOT cover in detail?
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When did you start the program?
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What is the quoted monthly payment amount?
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How many months are quoted for the program?
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How much debt is this quote for?
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How likely will you sign up with this debt relief provider?
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Bankruptcy Firm Name:
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Did you receive a quote?
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What was the quote?
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Would you like another free bankruptcy consultation to compare attorney fees and options?
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Debt management can be beneficial, but too expensive for many people. Are you able to keep up with the payments?
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Would you like us to compare other options for you that may fit your budget better?
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Income:

How often do you receive a paycheck?
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How much do you receive in your paycheck BEFORE taxes?
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How often does your SPOUSE receive a paycheck?
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How much does your SPOUSE receive in their paycheck BEFORE taxes?
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Estimated monthly overtime income
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Which of the following best represents your approximate annual overtime income?
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Do you receive income from any other sources, e.g. SSN income, VA disability, business, retirement, alimony, child supports, etc.?
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SSN Benefits monthly income
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VA Disability monthly income
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Business monthly income
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Teacher's annual income
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Retirement monthly income
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Alimony monthly income
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Child Support monthly income
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Other monthly income
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How consistent is the amount of your income?
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Accurate Income is Important

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Is your household annual income approximately $0
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Living Expenses:

What is your current living situation?
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Approximately how much equity (the difference of owed amount less value) do you have in your home?
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Have you looked into any of the following options to tap into home equity (Select all that apply)?
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Have you applied or are you in the process for any of the options selected above?
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Would you like to learn more about any of the potential options available?
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Approximately what is your home's value?
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Do you currently have any liens on the property?
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Monthly 1st mortgage payment
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Monthly 2nd mortgage payment:
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Monthly rental expenses for your residence (includes rent payment)
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If applicable, how many months are your behind on your mortgage as of this month?
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Do you want to keep this asset?
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If applicable, how many months are your behind on your 2nd mortgage as of this month?
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Do you own equity in any high value assets such as a vacation home, boat, RV, etc?
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How much equity do you own in these high value assets?
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Do you have any other assets of value greater than $1,000, including stocks, individual brokerage accounts, or retirement accounts?
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What is the value of your retirement account?
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What is the value of your non-retirement account?
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Automobile Expenses:

How many vehicles do you own or lease? Please include your spouse's vehicle(s) if they are filing with you.
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Automobile 1

Monthly automobile payment:
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What is the Year, Make, and Model of this vehicle?
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Approximately what is the interest rate of this vehicle?
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Is this vehicle titled in your name?
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If applicable, how many months are your behind on your automobile as of this month?
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Do you want to keep this asset?
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Automobile 2

Monthly 2nd automobile payment:
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What is the Year, Make, and Model of this vehicle?
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Approximately what is the interest rate of this vehicle?
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Is this vehicle titled in your name?
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If applicable, how many months are your behind on your 2nd automobile as of this month?
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Do you want to keep this asset?
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Other Expenses:

Do you have any outstanding balance on any such loans as jewelry, furniture, tvs, etc.?
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What is the balance of these loans?
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Do you want to keep this asset?
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What is the monthly amount that you pay for other debt that is secured by an asset, such as an RV, jet ski, jewelry, etc.?
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Which of the following best represents how much you pay annually to this secured debt?
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Did you receive a refund in your most recent tax filing?
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Do you know approximately how much tax debt you owe?
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Approximate tax debt you owe
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Do you owe any domestic support obligations such as child support or alimony in arrears?
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Alimony in arrears
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Child support in arrears
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Almost There!

Which of the following options would you like to compare estimates, and pros and cons of? Check all that apply
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Which of the following do you prefer?
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Would it be okay if we also sent you an email with your results and how to edit them in the future if you are not ready to take any actions?
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Note: Ascend and/or a reputable provider who is licensed in your area will contact you shortly to review the information provided in a free phone evaluation. Please do not pay for the first consultation as it should be 100% free and informational to help you determine your best debt relief option. By selecting a partner above to reach out to you, you agree that a partner may contact you (including autodials, pre-recorded calls, and SMS) to answer your questions about relief.

First Name
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Last Name
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Email address
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Phone Number
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You additionally give your consent to receive SMS text messages, phone calls or other communications from a bankruptcy attorney, Ascend, or another service provider to facilitate communication regarding your debt relief options, according to our Privacy Policy and Terms of Use. Message frequency varies. Standard message and data rates may apply. Text HELP for more information; text STOP to unsubscribe.
Disclaimer: Ascend strives to keep its information accurate and up to date. This information may be different from what you see when you visit a financial institution, service provider or specific product's site. All financial products, shopping products and services are presented without warranty, and estimated APR and other terms are not binding in any way. All loans presented on this page have a maximum APR of no greater than 35.99% with terms not less than 12 months to not more than 60 months. As an example, a $10,000 loan with an APR of 14.50% and a term of 36 months would cost $12,391.55 over the life of the loan. All rates are determined by the lender and must be agreed upon between the borrower and the borrower's chosen lender. Your actual APR will depend upon factors evaluated at the time of application, which may include credit score, loan amount, loan term, and credit history. All loans are subject to credit review and approval. When evaluating offers, please review the lender and/or lending partner's Terms and Conditions for additional details.