FREE CONSULTATION

In order for Burke, Jenson & Rose to help you, we need to find out a bit more about your situation. So, we'd like to to arrange for a completely free consultation with you. There's absolutely no obligation on your part, and there's no risk! Just fill out the following questionnaire, and we'll get back to you in 48 hours or less. What are you waiting for? You've got nothing to lose!

We respect your privacy! All information you submit to us will be treated completely confidentially. You don't have to worry about the safety of your personal information, because we won't ever give out your information to any third party, period.

Contact Information:
Your Name:
Company Name:
E-mail Address:
Daytime Phone No:
Best Time to Call:
How Did You
Find Us?
Your Current Situation:
What types of debts are currently unresolved?
Debt-related lawsuits Charge-offs
Judgements Unpaid Taxes
Liens Disputed Invoices or Contracts
Past-due accounts
How many accounts are past-due?
Do You have any agings over 90 days?
 Yes No - If yes... how many?
What is the total dollar amount of these unpaid debts?
 $
Do You have any lawsuits pending?
 Yes No - If yes... how many?
Do you have any judgments or UCC filings?
Yes No

If yes please explain:
Are there any tax liens against you or your business?
 Yes No

If yes please explain:
Have you considered or contacted an attorney regarding these debt-related matters?
 Yes No
Are you receiving any creditor collection calls?
 Yes No
Settlement Goals & Objectives:
How would like to solve these debt related matters?
If you want to structure long-term payment schedules with your creditors, what's the maximum amount of money (per month) that you can offer your creditors?
$

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